Robotic assited perineal prostatectomy (RAPP) as a new era for anesthesiology: It’s effects on hemodynamic parameters and respiratory mechanics

Robotic-assisted perineal prostatactomy(RAPP) is a new alternative surgical technique, in prostate cancer patients especially with a history of intra-abdominal surgery. The aim of this study is to examine the effects of the challenging patient position and CO₂ insufflation in perineal space during RAPP on both hemodynamic parameters and respiratory mechanics. Hemodynamic and respiratory parameters of 30 patients who underwent RAPP and 31 patients who underwent Robotic-assisted laparoscopic prostatectomy (RALP) for prostate cancer between 2017 and 2019 were retrospectively evaluated. Comparison between RAPP and RALP patients showed that anesthesia, surgery and insufflation times were shorter in RAPP patients (p < 0.05). Blood pCO₂ level was higher, and the pH decrease was more prominent in the RAPP patients 30 and 60 min after perineal CO₂ insufflation (p < 0.05). The mean arterial pressures, driving pressure, Ppeak and Pplato values were statistically higher in the RALP patients and 60 min after insufflation while static and dynamic lung compliance values were found to be lower. Our results showed that blood pCO₂ level may severely increase after perineal CO₂ insufflation. The fact that respiratory mechanics are less affected despite the difficult patient position for lungs in RAPP patients, the presence of higher CO₂ level supports that the perineal CO₂ insufflation plays a more important role in increased CO₂ level. Considering these changes, especially the sudden increase in the risk of CO₂ level, close follow-up and timely intervention by anesthesiology can ensure all changes remain in a clinically safe range.