Do Small Incisions Need Only Minimal Anesthesia?—Anesthetic Management in Laparoscopic and Robotic Surgery

Hottenrott, Sebastian; Schlesinger, Tobias; Helmer, Philipp; Meybohm, Patrick; Alkatout, İbrahim; Kranke, Peter

doi:10.3390/jcm9124058

Cited by 6 publications

(2 citation statements)

References 78 publications

(90 reference statements)

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“…Very few intra- and post-operative complications were noted in both cohorts. This may be a reflection of the more precise and less harmful surgical approach, which improves the short-term outcome and quality of life [ 1 , 6 , 7 , 12 , 35 , 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

The Role of ICG in Robot-Assisted Liver Resections

Mehdorn

Richter

Heß

et al. 2022

JCM

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Introduction: Robotic-assisted liver surgery (RALS) with its known limitations is gaining more importance. The fluorescent dye, indocyanine green (ICG), is a way to overcome some of these limitations. It accumulates in or around hepatic masses. The integrated near-infrared cameras help to visualize this accumulation. We aimed to compare the influence of ICG staining on the surgical and oncological outcomes in patients undergoing RALS. Material and Methods: Patients who underwent RALS between 2014 and 2021 at the Department of General Surgery at the University Hospital Schleswig-Holstein, Campus Kiel, were included. In 2019, ICG-supported RALS was introduced. Results: Fifty-four patients were included, with twenty-eight patients (50.9%) receiving preoperative ICG. Hepatocellular carcinoma (32.1%) was the main entity resected, followed by the metastasis of colorectal cancers (17%) and focal nodular hyperplasia (15.1%). ICG staining worked for different tumor entities, but diffuse staining was noted in patients with liver cirrhosis. However, ICG-supported RALS lasted shorter (142.7 ± 61.8 min vs. 246.4 ± 98.6 min, p < 0.001), tumors resected in the ICG cohort were significantly smaller (27.1 ± 25.0 mm vs. 47.6 ± 35.2 mm, p = 0.021) and more R0 resections were achieved by ICG-supported RALS (96.3% vs. 80.8%, p = 0.075). Conclusions: ICG-supported RALS achieve surgically and oncologically safe results, while overcoming the limitations of RALS.

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Section: Discussionmentioning

confidence: 99%

The Role of ICG in Robot-Assisted Liver Resections

Mehdorn

Richter

Heß

et al. 2022

JCM

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“…The first step in laparoscopic surgery is the induction of pneumoperitoneum. Gas insufflation is used to separate the abdominal wall from the intra-abdominal organs and achieve sufficient working space [2]. Different gases have been studied for the induction of pneumoperitoneum [3].…”

Section: Introductionmentioning

confidence: 99%

Restoration of Pulmonary Compliance after Laparoscopic Gynecologic Surgery Using a Recruitment Maneuver

Griva,

Talliou,

Rougeris

et al. 2024

JPM

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Background/Objectives: This study aimed to investigate the hypothesis that an alveolar recruitment maneuver can restore lung compliance to initial values after laparoscopic gynecological surgery. Methods: A total of 31 patients who underwent laparoscopic gynecological surgery were enrolled. Protective mechanical ventilation was applied, and the radial artery was catheterized in all patients. An alveolar recruitment maneuver (incremental and decremental positive end-expiratory pressure) was applied ten minutes after the release of pneumoperitoneum. The respiratory mechanics and blood gas results were recorded at eight different time points: after induction of anesthesia (T1), in the lithotomy position (T2), in the Trendelenburg position (T3), 10 and 90 min after insufflation of carbon dioxide (T4 and T5), in the supine position (T6), after desufflation (T7), and 10 min after an alveolar recruitment maneuver at the end of surgery (T8). Results: Pneumoperitoneum and the Trendelenburg position caused a decline of 15 units in compliance (T7 vs. T1; p < 0.05) compared to baseline. After the alveolar recruitment maneuver, compliance increased by 17.5% compared with the mean value of compliance at time T1 (T8 vs. T1; p < 0.05). The recruitment maneuver had favorable results in patients with low initial compliance (41.5 mL/cmH2O, IQR: 9.75 mL/cmH2O), high Body Mass Index 30.32 kg/m2 (IQR: 1.05 kg/m2), and high initial plateau airway pressure (16.5 cmH2O, IQR: 0.75 cmH2O). Conclusions: Lung compliance does not return to initial values after performing laparoscopic gynecological procedures. However, after the release of pneumoperitoneum, an alveolar recruitment maneuver is beneficial as it improves compliance and gas exchange.

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