Abstract
Laparoscopic techniques have become a standard approach for diagnostic and therapeutic procedures in many surgical disciplines. Recent progress in endoscopic surgery is based on the integration of computer-enhanced telemanipulation systems. Because robot-assisted radical prostatectomies take up to 10 hours, the present study was performed to evaluate the effects of prolonged intraperitoneal CO2 insufflation on hemodynamics and gas exchange in 15 patients with prostate cancer. When CO2 insufflation was initiated, peak inspiratory pressure increased and reached significant values after a 1.5-hour period of intraperitoneal CO2 insufflation. With the release of CO2, peak inspiratory pressure decreased close to baseline values. A significant increase in heart rate was observed after a 4-hour period of increased intraabdominal pressure. Mean arterial blood pressure and central venous pressure remained stable during CO2 insufflation. Minute ventilation was adjusted according to repeated blood gas analyses to maintain pH, base excess (BE), bicarbonate (HCO −3 ), and PaCO2 within physiologic ranges. The present data show, that prolonged CO2 insufflation during totally endoscopic robot-assisted radical prostatectomy results in only minor changes in hemodynamics and acid-base status. Because of the limited experience with long-term pneumoperitoneum, we consider invasive haemodynamic monitoring and repeat blood gas analysis essential for such operations.
Résumé
La technique laparoscopique est devenue le standard pour beaucoup de procédés diagnostiques et thérapeutiques dans diverses disciplines chirurgicales. De progrès récents en chirurgie endoscopique sont basés sur l’intégration de systèmes de la télémanipulation sur ordinateur. Puisque à présent, les prostatectomies radicales assistées par robot peuvent durer jusqu’à 10 heures, cette étude a été entreprise pour évaluer les effets de l’insufflation intrapéritonéale prolongée par le CO2 sur l’hémodynamique et les échanges gazeux chez 15 patients porteurs de cancer de la prostate. Au début de l’insufflation par le CO2, la pression inspiratoire maximale a augmenté et a atteint des valeurs significatives après 1.5 heures d’insufflation intrapéritonéale. Lorsque l’on a arrêté l’insufflation par le CO2, la pression inspiratorie maximale a diminué pour se rapprocher des valeurs de base. On a observé une augmentation significative de la fréquence cardiaque après 4 heures d’hyperpression intra-abdominale. La pression artérielle moyenne et la pression veineuse centrale sont restées stables pendant l’insufflation par le CO2. La ventilation minute a été ajustée selon les analyses des gaz du sang répétées pour maintenir le pH, la base-excès, les taux de HCO −3 et de PaCO2 dans les limites de la normale. Nos données actuelles nous montrent que l’insufflation prolongée de CO2 pendant la prostatectomie radicale endoscopique assistée par robot ne modifie que peu l’état hémodynamique et l’équilibre acido-basique. En raison d’une expérience limitée en ce qui concerne le pneumopéritoine prolongé, nous considérons que le monitorage hémodynamique invasif et l’analyse répétée des gaz du sang sont essentiels pour de telles opérations.
Resumen
En muchas especialidades quirúrgicas las técnicas laparoscópicas se han convertidomen en procedimientos estándar tanto con fines diagnósticos como terapéuticos. Progresos recientes han permitido integrar la cirugía endoscópica en sistemas computarizados propiciando las técnicas de telecirugía y telemanipulación. Dado que la prostatectomía radical con ayuda de un robot dura más de 10 horas, estudiamos los efectos de un neumoperitoneo prolongado con CO2 en la hemodinamia e intercambio gaseoso en 15 pacientes con cáncer de próstata. Al iniciar la insuflación de CO2 la presión inspiratoria aumenta y alcanza valores significativos a las 1–5 horas de la instauración del neumoperitoneo. Cuando éste desaparece la presión inspiratoria máxima desciende a nivel basai. La presión arterial media (MAP) y la venosa central (PVC) se mantienen estables durante el neumoperitoneo. La ventilación minuto ha de ajustarse de acuerdo con gasometrías repetidas para mantener dentro de límites normales el pH, BE, HCQ −3 y la PaCO2. Nuestros hallazgos demuestran que el neumoperitoneo prolongado por prostatectomía radical asistida mediante un robot produce cambios mínimos hemodinámicos y del equilibro ácido-base. Dada la corta experiencia con neumoperitoneo de larga duración, en estas operaciones son obligatorios la monitorización invasiva hemodinámica y frecuentes análisis gasométricos.
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Published Online: September 26, 2002
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Meininger, D., Byhahn, C., Bueck, M. et al. Effects of prolonged pneumoperitoneum on hemodynamics and acid-base balance during totally endoscopic robot-assisted radical prostatectomies. World J. Surg. 26, 1423–1427 (2002). https://doi.org/10.1007/s00268-002-6404-7
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DOI: https://doi.org/10.1007/s00268-002-6404-7