Skip to main content
Top

Open Access 17-06-2024 | Prostatectomy | Original Research

Mechanical power during robotic-assisted laparoscopic prostatectomy: an observational study

Authors: Tommaso Pozzi, Silvia Coppola, Giulia Catozzi, Andrea Colombo, Mara Chioccola, Eleonora Duscio, Fabiano Di Marco, Davide Chiumello

Published in: Journal of Clinical Monitoring and Computing

Login to get access

Abstract

Background

Robotic-assisted laparoscopic radical prostatectomy (RALP) requires pneumoperitoneum and steep Trendelenburg position. Our aim was to investigate the influence of the combination of pneumoperitoneum and Trendelenburg position on mechanical power and its components during RALP.

Methods

Sixty-one prospectively enrolled patients scheduled for RALP were studied in supine position before surgery, during pneumoperitoneum and Trendelenburg position and in supine position after surgery at constant ventilatory setting. In a subgroup of 17 patients the response to increasing positive end-expiratory pressure (PEEP) from 5 to 10 cmH2O was studied.

Results

The application of pneumoperitoneum and Trendelenburg position increased the total mechanical power (13.8 [11.6 – 15.5] vs 9.2 [7.5 – 11.7] J/min, p < 0.001) and its elastic and resistive components compared to supine position before surgery. In supine position after surgery the total mechanical power and its elastic component decreased but remained higher compared to supine position before surgery. Increasing PEEP from 5 to 10 cmH2O within each timepoint significantly increased the total mechanical power (supine position before surgery: 9.8 [8.4 – 10.4] vs 12.1 [11.4 – 14.2] J/min, p < 0.001; pneumoperitoneum and Trendelenburg position: 13.8 [12.2 – 14.3] vs 15.5 [15.0 – 16.7] J/min, p < 0.001; supine position after surgery: 10.2 [9.4 – 10.7] vs 12.7 [12.0 – 13.6] J/min, p < 0.001), without affecting respiratory system elastance.

Conclusion

Mechanical power in healthy patients undergoing RALP significantly increased both during the pneumoperitoneum and Trendelenburg position and in supine position after surgery. PEEP always increased mechanical power without ameliorating the respiratory system elastance.
Literature
1.
go back to reference Basiri A, de la Rosette JJ, Tabatabaei S, Woo HH, Laguna MP, Shemshaki H. Comparison of retropubic, laparoscopic and robotic radical prostatectomy: who is the winner? World J Urol. 2018;36:609–21.CrossRefPubMed Basiri A, de la Rosette JJ, Tabatabaei S, Woo HH, Laguna MP, Shemshaki H. Comparison of retropubic, laparoscopic and robotic radical prostatectomy: who is the winner? World J Urol. 2018;36:609–21.CrossRefPubMed
2.
go back to reference Du Y, Long Q, Guan B, Mu L, Tian J, Jiang Y, et al. Robot-Assisted Radical Prostatectomy Is More Beneficial for Prostate Cancer Patients: A System Review and Meta-Analysis. Med Sci Monit. 2018;24:272–87.CrossRefPubMedPubMedCentral Du Y, Long Q, Guan B, Mu L, Tian J, Jiang Y, et al. Robot-Assisted Radical Prostatectomy Is More Beneficial for Prostate Cancer Patients: A System Review and Meta-Analysis. Med Sci Monit. 2018;24:272–87.CrossRefPubMedPubMedCentral
3.
go back to reference Carbonara U, Srinath M, Crocerossa F, Ferro M, Cantiello F, Lucarelli G, et al. Robot-assisted radical prostatectomy versus standard laparoscopic radical prostatectomy: an evidence-based analysis of comparative outcomes. World J Urol. 2021;39:3721–32.CrossRefPubMed Carbonara U, Srinath M, Crocerossa F, Ferro M, Cantiello F, Lucarelli G, et al. Robot-assisted radical prostatectomy versus standard laparoscopic radical prostatectomy: an evidence-based analysis of comparative outcomes. World J Urol. 2021;39:3721–32.CrossRefPubMed
4.
go back to reference Autorino R, Porpiglia F. Robotic surgery in urology: the way forward. World J Urol. 2020;38:809–11.CrossRefPubMed Autorino R, Porpiglia F. Robotic surgery in urology: the way forward. World J Urol. 2020;38:809–11.CrossRefPubMed
5.
go back to reference Aceto P, Galletta C, Cambise C, et al. Challenges for anaesthesia for robotic-assisted surgery in the elderly. Europ J Anaesthesiol Intensive Care. 2023;2:e0019.CrossRef Aceto P, Galletta C, Cambise C, et al. Challenges for anaesthesia for robotic-assisted surgery in the elderly. Europ J Anaesthesiol Intensive Care. 2023;2:e0019.CrossRef
6.
go back to reference Brandão JC, Lessa MA, Motta-Ribeiro G, et al. Global and Regional Respiratory Mechanics During Robotic-Assisted Laparoscopic Surgery: A Randomized Study. Anesth Analg. 2019;129:1564–73.CrossRefPubMed Brandão JC, Lessa MA, Motta-Ribeiro G, et al. Global and Regional Respiratory Mechanics During Robotic-Assisted Laparoscopic Surgery: A Randomized Study. Anesth Analg. 2019;129:1564–73.CrossRefPubMed
7.
go back to reference Kalmar AF, Foubert L, Hendrickx JFA, et al. Influence of steep Trendelenburg position and CO2 pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy. Br J Anaesth. 2010;104:433–9.CrossRefPubMed Kalmar AF, Foubert L, Hendrickx JFA, et al. Influence of steep Trendelenburg position and CO2 pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy. Br J Anaesth. 2010;104:433–9.CrossRefPubMed
8.
go back to reference Lestar M, Gunnarsson L, Lagerstrand L, et al. Hemodynamic Perturbations During Robot-Assisted Laparoscopic Radical Prostatectomy in 45° Trendelenburg Position. Anesth Analg. 2011;113:1069–75.CrossRefPubMed Lestar M, Gunnarsson L, Lagerstrand L, et al. Hemodynamic Perturbations During Robot-Assisted Laparoscopic Radical Prostatectomy in 45° Trendelenburg Position. Anesth Analg. 2011;113:1069–75.CrossRefPubMed
9.
go back to reference Young CC, Harris EM, Vacchiano C, et al. Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations. Br J Anaesth. 2019;123:898–913.CrossRefPubMed Young CC, Harris EM, Vacchiano C, et al. Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations. Br J Anaesth. 2019;123:898–913.CrossRefPubMed
10.
go back to reference Ladha K, Vidal Melo MF, McLean DJ, Wanderer JP, Grabitz SD, Kurth T, Eikermann M. Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications: hospital based registry study. BMJ. 2015;351:h3646. https://doi.org/10.1136/bmj.h3646. Ladha K, Vidal Melo MF, McLean DJ, Wanderer JP, Grabitz SD, Kurth T, Eikermann M. Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications: hospital based registry study. BMJ. 2015;351:h3646. https://​doi.​org/​10.​1136/​bmj.​h3646.
11.
go back to reference Corcione F, Esposito C, Cuccurullo D, Settembre A, Miranda N, Amato F, et al. Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience. Surg Endosc. 2005;19:117–9.CrossRefPubMed Corcione F, Esposito C, Cuccurullo D, Settembre A, Miranda N, Amato F, et al. Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience. Surg Endosc. 2005;19:117–9.CrossRefPubMed
12.
go back to reference Güldner A, Kiss T, Serpa Neto A, et al. Intraoperative Protective Mechanical Ventilation for Prevention of Postoperative Pulmonary Complications. Anesthesiology. 2015;123:692–713.CrossRefPubMed Güldner A, Kiss T, Serpa Neto A, et al. Intraoperative Protective Mechanical Ventilation for Prevention of Postoperative Pulmonary Complications. Anesthesiology. 2015;123:692–713.CrossRefPubMed
13.
go back to reference Suleiman A, Costa E, Santer P, et al. Association between intraoperative tidal volume and postoperative respiratory complications is dependent on respiratory elastance: a retrospective, multicentre cohort study. Br J Anaesth. 2022;129:263–72.CrossRefPubMedPubMedCentral Suleiman A, Costa E, Santer P, et al. Association between intraoperative tidal volume and postoperative respiratory complications is dependent on respiratory elastance: a retrospective, multicentre cohort study. Br J Anaesth. 2022;129:263–72.CrossRefPubMedPubMedCentral
14.
go back to reference Hol L, Nijbroek SGLH, Schultz MJ. Perioperative Lung Protection: Clinical Implications. Anesth Analg. 2020;131:1721–9.CrossRefPubMed Hol L, Nijbroek SGLH, Schultz MJ. Perioperative Lung Protection: Clinical Implications. Anesth Analg. 2020;131:1721–9.CrossRefPubMed
15.
go back to reference Collino F, Rapetti F, Vasques F, et al. Positive End-expiratory Pressure and Mechanical Power. Anesthesiology. 2019;130:119–30.CrossRefPubMed Collino F, Rapetti F, Vasques F, et al. Positive End-expiratory Pressure and Mechanical Power. Anesthesiology. 2019;130:119–30.CrossRefPubMed
16.
go back to reference Gattinoni L, Tonetti T, Cressoni M, Cadringher P, Herrmann P, Moerer O, et al. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med. 2016;42:1567–75.CrossRefPubMed Gattinoni L, Tonetti T, Cressoni M, Cadringher P, Herrmann P, Moerer O, et al. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med. 2016;42:1567–75.CrossRefPubMed
17.
go back to reference Chiumello D, Gotti M, Guanziroli M, Formenti P, Umbrello M, Pasticci I, et al. Bedside calculation of mechanical power during volume- and pressure-controlled mechanical ventilation. Crit Care. 2020;24:417.CrossRefPubMedPubMedCentral Chiumello D, Gotti M, Guanziroli M, Formenti P, Umbrello M, Pasticci I, et al. Bedside calculation of mechanical power during volume- and pressure-controlled mechanical ventilation. Crit Care. 2020;24:417.CrossRefPubMedPubMedCentral
18.
go back to reference Schuijt MTU, Hol L, Nijbroek SG, et al. Associations of dynamic driving pressure and mechanical power with postoperative pulmonary complications–posthoc analysis of two randomised clinical trials in open abdominal surgery. EClinicalMedicine. 2022;47: 101397.CrossRefPubMedPubMedCentral Schuijt MTU, Hol L, Nijbroek SG, et al. Associations of dynamic driving pressure and mechanical power with postoperative pulmonary complications–posthoc analysis of two randomised clinical trials in open abdominal surgery. EClinicalMedicine. 2022;47: 101397.CrossRefPubMedPubMedCentral
19.
go back to reference Santer P, Wachtendorf LJ, Suleiman A, et al. Mechanical Power during General Anesthesia and Postoperative Respiratory Failure: A Multicenter Retrospective Cohort Study. Anesthesiology. 2022;137:41–54.CrossRefPubMed Santer P, Wachtendorf LJ, Suleiman A, et al. Mechanical Power during General Anesthesia and Postoperative Respiratory Failure: A Multicenter Retrospective Cohort Study. Anesthesiology. 2022;137:41–54.CrossRefPubMed
20.
go back to reference Karalapillai D, Weinberg L, Neto AS, et al. Intra-operative ventilator mechanical power as a predictor of postoperative pulmonary complications in surgical patients. Eur J Anaesthesiol. 2022;39:67–74.CrossRefPubMed Karalapillai D, Weinberg L, Neto AS, et al. Intra-operative ventilator mechanical power as a predictor of postoperative pulmonary complications in surgical patients. Eur J Anaesthesiol. 2022;39:67–74.CrossRefPubMed
21.
go back to reference Fratti I, Pozzi T, Corrente M, Galetta G, Lopez P, Grieco S, et al. Effect of PEEP variation on mechanical power in healthy patients during general anesthesia. ESCIM Abstract Collection. 2023. Fratti I, Pozzi T, Corrente M, Galetta G, Lopez P, Grieco S, et al. Effect of PEEP variation on mechanical power in healthy patients during general anesthesia. ESCIM Abstract Collection. 2023.
22.
go back to reference Girrbach F, Petroff D, Schulz S, et al. Individualised positive end-expiratory pressure guided by electrical impedance tomography for robot-assisted laparoscopic radical prostatectomy: a prospective, randomised controlled clinical trial. Br J Anaesth. 2020;125:373–82.CrossRefPubMed Girrbach F, Petroff D, Schulz S, et al. Individualised positive end-expiratory pressure guided by electrical impedance tomography for robot-assisted laparoscopic radical prostatectomy: a prospective, randomised controlled clinical trial. Br J Anaesth. 2020;125:373–82.CrossRefPubMed
23.
go back to reference Stolzenburg J-U, Kallidonis P, Qazi H, Ho Thi P, Dietel A, Liatsikos EN, et al. Extraperitoneal Approach for Robotic-assisted Simple Prostatectomy. Urology. 2014;84:1099–105.CrossRefPubMed Stolzenburg J-U, Kallidonis P, Qazi H, Ho Thi P, Dietel A, Liatsikos EN, et al. Extraperitoneal Approach for Robotic-assisted Simple Prostatectomy. Urology. 2014;84:1099–105.CrossRefPubMed
24.
go back to reference Neto AS, Hemmes SNT, Barbas CSV, Beiderlinden M, Fernandez-Bustamante A, Futier E, et al. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data. Lancet Respir Med. 2016;4:272–80.CrossRefPubMed Neto AS, Hemmes SNT, Barbas CSV, Beiderlinden M, Fernandez-Bustamante A, Futier E, et al. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data. Lancet Respir Med. 2016;4:272–80.CrossRefPubMed
25.
go back to reference Coppola S, Caccioppola A, Froio S, Formenti P, De Giorgis V, Galanti V, et al. Effect of mechanical power on intensive care mortality in ARDS patients. Crit Care. 2020;24:246.CrossRefPubMedPubMedCentral Coppola S, Caccioppola A, Froio S, Formenti P, De Giorgis V, Galanti V, et al. Effect of mechanical power on intensive care mortality in ARDS patients. Crit Care. 2020;24:246.CrossRefPubMedPubMedCentral
26.
go back to reference Pozzi T, Fratti I, Tomarchio E, Bruno G, Catozzi G, Monte A, et al. Early time-course of respiratory mechanics, mechanical power and gas exchange in ARDS patients. J Crit Care. 2024;79:154444.CrossRefPubMed Pozzi T, Fratti I, Tomarchio E, Bruno G, Catozzi G, Monte A, et al. Early time-course of respiratory mechanics, mechanical power and gas exchange in ARDS patients. J Crit Care. 2024;79:154444.CrossRefPubMed
27.
go back to reference EL Costa V, Slutsky AS, Brochard LJ, Brower R, Serpa-Neto A, Cavalcanti AB, et al. Ventilatory Variables and Mechanical Power in Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2021;204:303–11.CrossRefPubMed EL Costa V, Slutsky AS, Brochard LJ, Brower R, Serpa-Neto A, Cavalcanti AB, et al. Ventilatory Variables and Mechanical Power in Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2021;204:303–11.CrossRefPubMed
28.
go back to reference Tharp WG, Neilson MR, Breidenstein MW, et al. Effects of obesity, pneumoperitoneum, and body position on mechanical power of intraoperative ventilation: an observational study. J Appl Physiol. 2023;134:1390–402.CrossRefPubMedPubMedCentral Tharp WG, Neilson MR, Breidenstein MW, et al. Effects of obesity, pneumoperitoneum, and body position on mechanical power of intraoperative ventilation: an observational study. J Appl Physiol. 2023;134:1390–402.CrossRefPubMedPubMedCentral
29.
go back to reference Rocco PRM, Silva PL, Samary CS, et al. Elastic power but not driving power is the key promoter of ventilator-induced lung injury in experimental acute respiratory distress syndrome. Crit Care. 2020;24:284.CrossRefPubMedPubMedCentral Rocco PRM, Silva PL, Samary CS, et al. Elastic power but not driving power is the key promoter of ventilator-induced lung injury in experimental acute respiratory distress syndrome. Crit Care. 2020;24:284.CrossRefPubMedPubMedCentral
30.
go back to reference Lee HJ, Kim KS, Jeong JS, et al. Optimal positive end-expiratory pressure during robot-assisted laparoscopic radical prostatectomy. Korean J Anesthesiol. 2013;65:244.CrossRefPubMedPubMedCentral Lee HJ, Kim KS, Jeong JS, et al. Optimal positive end-expiratory pressure during robot-assisted laparoscopic radical prostatectomy. Korean J Anesthesiol. 2013;65:244.CrossRefPubMedPubMedCentral
31.
go back to reference Blecha S, Hager A, Gross V, et al. Effects of Individualised High Positive End-Expiratory Pressure and Crystalloid Administration on Postoperative Pulmonary Function in Patients Undergoing Robotic-Assisted Radical Prostatectomy: A Prospective Randomised Single-Blinded Pilot Study. J Clin Med. 2023;12:1460.CrossRefPubMedPubMedCentral Blecha S, Hager A, Gross V, et al. Effects of Individualised High Positive End-Expiratory Pressure and Crystalloid Administration on Postoperative Pulmonary Function in Patients Undergoing Robotic-Assisted Radical Prostatectomy: A Prospective Randomised Single-Blinded Pilot Study. J Clin Med. 2023;12:1460.CrossRefPubMedPubMedCentral
32.
go back to reference Cheng M, Ni L, Huang L, et al. Effect of positive end-expiratory pressure on pulmonary compliance and pulmonary complications in patients undergoing robot-assisted laparoscopic radical prostatectomy: a randomized control trial. BMC Anesthesiol. 2022;22:347.CrossRefPubMedPubMedCentral Cheng M, Ni L, Huang L, et al. Effect of positive end-expiratory pressure on pulmonary compliance and pulmonary complications in patients undergoing robot-assisted laparoscopic radical prostatectomy: a randomized control trial. BMC Anesthesiol. 2022;22:347.CrossRefPubMedPubMedCentral
33.
go back to reference Yoon H-K, Kim BR, Yoon S, et al. The Effect of Ventilation with Individualized Positive End-Expiratory Pressure on Postoperative Atelectasis in Patients Undergoing Robot-Assisted Radical Prostatectomy: A Randomized Controlled Trial. J Clin Med. 2021;10:850.CrossRefPubMedPubMedCentral Yoon H-K, Kim BR, Yoon S, et al. The Effect of Ventilation with Individualized Positive End-Expiratory Pressure on Postoperative Atelectasis in Patients Undergoing Robot-Assisted Radical Prostatectomy: A Randomized Controlled Trial. J Clin Med. 2021;10:850.CrossRefPubMedPubMedCentral
34.
go back to reference Zhou J, Wang C, Lv R, et al. Protective mechanical ventilation with optimal PEEP during RARP improves oxygenation and pulmonary indexes. Trials. 2021;22:351.CrossRefPubMedPubMedCentral Zhou J, Wang C, Lv R, et al. Protective mechanical ventilation with optimal PEEP during RARP improves oxygenation and pulmonary indexes. Trials. 2021;22:351.CrossRefPubMedPubMedCentral
35.
go back to reference Young CC, Harris EM, Vacchiano C, Bodnar S, Bukowy B, Elliott RRD, et al. Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations. Br J Anaesth. 2019;123:898–913.CrossRefPubMed Young CC, Harris EM, Vacchiano C, Bodnar S, Bukowy B, Elliott RRD, et al. Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations. Br J Anaesth. 2019;123:898–913.CrossRefPubMed
36.
go back to reference Gutt CN, Oniu T, Mehrabi A, Kashfi A, Schemmer P, Büchler MW. Robot-assisted abdominal surgery. Br J Surg. 2004;91:1390–7.CrossRefPubMed Gutt CN, Oniu T, Mehrabi A, Kashfi A, Schemmer P, Büchler MW. Robot-assisted abdominal surgery. Br J Surg. 2004;91:1390–7.CrossRefPubMed
37.
go back to reference Covotta M, Claroni C, Torregiani G, et al. A Prospective, Randomized, Clinical Trial on the Effects of a Valveless Trocar on Respiratory Mechanics During Robotic Radical Cystectomy: A Pilot Study. Anesth Analg. 2017;124:1794–801.CrossRefPubMed Covotta M, Claroni C, Torregiani G, et al. A Prospective, Randomized, Clinical Trial on the Effects of a Valveless Trocar on Respiratory Mechanics During Robotic Radical Cystectomy: A Pilot Study. Anesth Analg. 2017;124:1794–801.CrossRefPubMed
38.
go back to reference Horstmann M, Horton K, Kurz M, et al. Prospective Comparison Between the AirSeal® System Valve-Less Trocar and a Standard Versaport™ Plus V2 Trocar in Robotic-Assisted Radical Prostatectomy. J Endourol. 2013;27:579–82.CrossRefPubMed Horstmann M, Horton K, Kurz M, et al. Prospective Comparison Between the AirSeal® System Valve-Less Trocar and a Standard Versaport™ Plus V2 Trocar in Robotic-Assisted Radical Prostatectomy. J Endourol. 2013;27:579–82.CrossRefPubMed
Metadata
Title
Mechanical power during robotic-assisted laparoscopic prostatectomy: an observational study
Authors
Tommaso Pozzi
Silvia Coppola
Giulia Catozzi
Andrea Colombo
Mara Chioccola
Eleonora Duscio
Fabiano Di Marco
Davide Chiumello
Publication date
17-06-2024
Publisher
Springer Netherlands
Published in
Journal of Clinical Monitoring and Computing
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI
https://doi.org/10.1007/s10877-024-01170-1