Assessing the complications of laparoscopic robot-assisted surgery: the case of radical prostatectomy

Lebeau, Thierry; Rouprêt, Morgan; Ferhi, K.; Chartier‐Kastler, Emmanuel; Richard, François; Bitker, Marc‐Olivier; Vaessen, Christophe

doi:10.1007/s00464-010-1210-z

Cited by 31 publications

(21 citation statements)

References 26 publications

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“…With the exception of senior residents and fellows involved in ORP, all cases that involved trainee participation were associated with equivalent or less morbidity than that reported in other studies. 8,9,[20][21][22] In ORP cases, this increased morbidity was driven by bleeding rates in the PGY 6-10 group (30.4% vs. 4.7% for attending without trainee). Increased morbidity in cases involving resident surgeons has been demonstrated previously in the general surgical 300 CARAS ET AL.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Radical Prostatectomy Demonstrates Less Morbidity Than Open Radical Prostatectomy: An Analysis of the American College of Surgeons-National Surgical Quality Improvement Program Database with a Focus on Surgical Trainee Involvement

CarasRonald

LustikMichael²,

KernSean³

et al. 2014

Journal of Endourology

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The large sample size, standardized data definitions, and quality control measures of the ACS-NSQIP database allow for in-depth analysis of subtle, but significant differences in outcomes between groups. Trainee involvement in LRP appears safe to patients. However, the increased morbidity in ORP involving trainees may be mitigated by awareness, simulation laboratories, and standardized competency assessment.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Radical Prostatectomy Demonstrates Less Morbidity Than Open Radical Prostatectomy: An Analysis of the American College of Surgeons-National Surgical Quality Improvement Program Database with a Focus on Surgical Trainee Involvement

CarasRonald

LustikMichael²,

KernSean³

et al. 2014

Journal of Endourology

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“…Relatively high pneumoperitoneum with steep Trendelenburg position during RALP may cause adverse events in patients , such as myocardial infarction and subsequent death , laryngeal oedema , pulmonary oedema and optic ischaemic neuropathy . Laryngeal oedema occurred under pneumoperitoneum and prolonged (4.5 h) 45° head‐down position ; the pulmonary oedema was attributed to prolonged (4 h) pneumoperitoneum with concomitant high intra‐abdominal pressure of up to 20 mmHg to minimize bleeding ; intraocular pressure reached peak levels at the end of 25° head‐down position with pneumoperitoneum of 15 mmHg, on average 13.3 mmHg higher than the preinduction value in the supine position at the end of the Trendelenburg position.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular and respiratory effects of the degree of head‐down angle during robot‐assisted laparoscopic radical prostatectomy

Kadono

Yaegashi

Machioka

et al. 2013

Robotics Computer Surgery

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IntroductionRobot-assisted laparoscopic radical prostatectomy (RALP) has been used worldwide in the treatment of localized prostate cancer because of its minimal invasiveness compared to open retropubic radical prostatectomy (RRP) (1,2). RALP provides a number of benefits, such as reduced blood loss, less postoperative pain, and shorter hospital stay than other methods. However, RALP requires a steep Trendelenburg (head-down) position and CO 2 pneumoperitoneum for several hours to secure the surgical visual field. The steep Trendelenburg position and pneumoperitoneum cause significant changes in cardiovascular, respiratory, and neurophysiological parameters (3,4). Pneumoperitoneum influences intrathoracic pressure by pushing the diaphragm upward, and the head-down position further changes the position of the intestine and diaphragm, thus reducing lung volume and decreasing respiratory system compliance.Pneumoperitoneum with head-down position also causes circulatory perturbation. The mean arterial pressure (MAP) as well as right and left ventricular filling pressures, e.g., central venous pressure and pulmonary capillary wedge pressure, increase markedly under these conditions (5).There have been several reports of anesthetic complications after RALP-a patient with post-extubation respiratory distress required reintubation and subsequent ventilation in an intensive care unit (6), a patient developed sudden pulmonary edema after uneventful RALP (7), and two patients developed postoperative ischemic optic neuropathy after RALP(8). These complications were mainly caused by steep head-down position and pneumoperitoneum during the operation.Some previous studies indicated the influence of head-down position and pneumoperitoneum on the cardiovascular and respiratory system during RALP.However, to our knowledge, the effects of different head-down angles on cardiac and respiratory function have not been determined during RALP. The present study was performed to investigate the influence of different Trendelenburg position angles with pneumoperitoneum during RALP on cardiovascular and respiratory homeostasis. Materials and methodsApproval for the study was obtained from Institutional Ethics Committee at Kanazawa University Hospital. After obtaining written informed consent, 48 patients, who were assessed with the American Society of Anesthesiologists Physical Status (ASA PS) classification system and evaluated as ASA PS 1 or 2, were recruited. Patients with a history of valvular heart desease, myocardial infarction, chronic obstructive or restrictive pulmonary disease, heavy smoking, renal insufficiency, or neurological disease were excluded from the study. Each patient selected RRP or RALP, and 12 patients undergoing RRP and 36 patients undergoing RALP were enrolled in this study.The patients who selected RALP were randomly divided into three groups: each patient placed in the 20°, 25°, or 30° head-down position during the operation (Fig.1). But there was a concern of the sight of the operation space with a patient sele...

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“…Overall, the majority of respondents felt that the Clavien‐Dindo grading scale is applicable to head and neck surgery and that a standardized system for grading complications would be useful for their clinical practice, as well as for reporting complications in research studies. The Clavien‐Dindo grading scale is easy to use and has been demonstrated to be a reliable and valid complication grading scale in general surgery as well as in other surgical fields . However, there are some potential limitations for its use in grading complications specific to head and neck surgery, as highlighted in the results.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the Clavien-Dindo classification system for complications in head and neck surgery

et al. 2014

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Assessing the complications of laparoscopic robot-assisted surgery: the case of radical prostatectomy

Abstract: The findings show that RALRP is a safe alternative to classical surgery and that the robotic approach is reliable. The authors believe that the reliability of technological devices should be systematically discussed when outcome analysis of a new procedure is performed.

Cited by 31 publications

References 26 publications

Laparoscopic Radical Prostatectomy Demonstrates Less Morbidity Than Open Radical Prostatectomy: An Analysis of the American College of Surgeons-National Surgical Quality Improvement Program Database with a Focus on Surgical Trainee Involvement

Laparoscopic Radical Prostatectomy Demonstrates Less Morbidity Than Open Radical Prostatectomy: An Analysis of the American College of Surgeons-National Surgical Quality Improvement Program Database with a Focus on Surgical Trainee Involvement

Cardiovascular and respiratory effects of the degree of head‐down angle during robot‐assisted laparoscopic radical prostatectomy

Assessment of the Clavien-Dindo classification system for complications in head and neck surgery

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