Transvesical Percutaneous Access Allows for Epidural Anesthesia Without Mechanical Ventilation in Single-Port Robotic Radical and Simple Prostatectomy

Abstract

ObjectivesTo determine the feasibility of epidural anesthesia in patients undergoing transvesical single-port (SP) robotic simple and radical prostatectomy. MethodsPatients undergoing transvesical SP robotic radical or simple prostatectomy were selected. Exclusions were underlying obstructive sleep apnea, pulmonary disease, prior lumbar spinal surgery, or BMI >35. Low thoracic or high lumbar epidural catheters were placed in the preoperative unit prior to operating room transport. Demographic information, intraoperative variables, and perioperative outcomes were collected in an IRB-approved database. A descriptive statistical analysis was performed. ResultsA total of 12 patients underwent epidural placement prior to transvesical SP radical (N = 7) and simple (N = 5) prostatectomy. All cases were completed without extra ports, open conversion, or conversion to general anesthesia. No surgical interruptions were noted in 9 of 12 cases and all movement-related interruptions were brief and transient. No anesthetic complications were noted. The one postoperative complication noted was unrelated to anesthesia. Intraoperative opioids were avoided in 5 patients. No patients required opioid medications after discharge and all patients with outpatient encounters were same-day discharges. One patient was a pre-planned admission. Limitations include small number of patients and a single surgeon experience. ConclusionEpidural anesthesia without mechanical ventilation is a safe and feasible technique in selected patients undergoing transvesical SP robotic radical and simple prostatectomy. This approach was not associated with any anesthesia-related complications or compromise in perioperative outcomes.