Robotic-Assisted Laparoscopic Surgery: Lower Insufflation Pressures Reduced the Risk of Hemodynamic Instability

Abstract

<h3>Study Objective</h3> The objective is to assess hemodynamic changes with lower abdominal insufflation pressures of pneumoperitoneum during robotic-assisted laparoscopic surgery. <h3>Design</h3> Quality improvement project in robotic surgical patients with an intervention to improve hemodynamic changes during insufflation and positioning. <h3>Setting</h3> All patients were placed in standard dorsal lithotomy, standardized to a Trendelenburg position of 23 degrees after abdominal insufflation. <h3>Patients or Participants</h3> A total of 21 patients undergoing robotic-assisted laparoscopic gynecologic surgery were selected, all of which operated on by the same surgeon. <h3>Interventions</h3> Patients were randomized to two groups: (1) standard insufflation pressure of 15 mmHg and, (2) low insufflation pressure of 12 mmHg. <h3>Measurements and Main Results</h3> Baseline hemodynamics and ventilator readings were noted. Changes in these parameters following insufflation and positioning were then recorded, including any interventions necessary to maintain homeostasis over the subsequent 15 minutes. Data were tabulated and compared amongst the two groups. Independent sample T-tests were used to analyze hemodynamic outcome means between groups. Insufflation groups did not differ based on BMI status (p = 0.72) and had equal quality of visualization as determined by a single surgeon. Patients at higher insufflation pressures on average had significantly more hemodynamic instability events requiring treatments than the lower insufflation pressure group, 2.0 vs 0.33, respectively (p=0.005). Systolic blood pressures (BP), Diastolic BP, and mean arterial pressures showed clear trends of improvements in the low-insufflation group, with mean deltas of +10.0, +19.6, and +16.6, respectively. <h3>Conclusion</h3> This quality improvement project showed that a lower abdominal insufflation pressure decreased hemodynamic instability events during robotic-assisted laparoscopic gynecology surgeries without impacting the surgical visualization.