Postoperative renal function in patients is unaltered after robotic-assisted radical prostatectomy

Abstract

BackgroundPneumoperitoneum with an intra-abdominal pressure (IAP) of 14 mmHg is known to decrease renal function. Robotic-assisted radical prostatectomy (RARP) requires an IAP of more than 15 mmHg for operation. Therefore, we retrospectively investigated whether patients who underwent RARP experienced renal insufficiency during the postoperative period (at postoperative days 7 and 30).MethodsOne hundred patients who underwent RARP were enrolled in this study. Preoperative serum blood urea nitrogen (BUN) and serum creatinine (Cr) levels were measured. Creatinine clearance (CrCl) was calculated using the Cockcroft and Gault formula. CrCl was calculated at 1 day before surgery (baseline), 2 hr postoperatively, and at 1, 3, 7, and 30 days postoperatively (POD 1, POD 3, POP 7, and POD 30). Patients were assigned to abnormal CrCl (n = 52) or normal CrCl groups (n = 48) on the basis of these measurements.ResultsSignificant inter-group differences in BUN, Cr, and CrCl were observed at all postoperative time points. BUN and Cr decreased significantly at postoperative 2 hr and POD 1, 3, and 7 versus baseline in both groups, whereas CrCl increased significantly at postoperative 2 hr and POD 1, 3, and 7 versus baseline in both groups. However, BUN, Cr, and CrCl were similar at POD 30 and preoperatively in the two groups.ConclusionsRAPR, which requires an IAP of 15-20 mmHg for more than 4 hr, does not induce renal dysfunction during the postoperative period, and even in those patients with an abnormal CrCl.

Transient acute kidney injury observed immediately after robot‑assisted radical prostatectomy but not after open radical prostatectomy

“…However, another study showed a completely opposite result; i.e., the incidence of AKI after RARP was significantly lower than that after ORP (5). In yet other studies, postoperative renal function was unaltered in patients who underwent RARP (3,6). These inconsistencies might be attributable to the diagnostic time of AKI or the timing of blood sampling, given that fewer patients who underwent RARP than ORP in our study met the AKI criteria on POD1 (<24 h after surgery).…”

“…To the contrary, another study reported that the incidence of AKI after RARP was significantly lower than that after ORP (5). Yet other studies reported that postoperative renal function was unaltered in patients who underwent RARP (3,6). Therefore, there is currently no consensus regarding the risk of AKI after RARP.…”

“…Although RARP is reportedly associated with safer surgery and better oncological outcomes than conventional open radical prostatectomy (ORP) (1), RARP has risks of specific complications due to the use of carbon dioxide pneumoperitoneum and a steep Trendelenburg position (2,3). Acute kidney injury (AKI) is a serious postoperative complication especially after laparoscopic surgery; however, the link between RARP and AKI is controversial (2)(3)(4)(5)(6). A previous study reported that the postoperative serum creatinine (sCre) concentration increased in patients who underwent RARP but decreased in those who underwent ORP (2).…”

Comparison of renal function after robot - assisted laparoscopic radical prostatectomy versus retropubic radical prostatectomy

“…The authors have said that RALP does not lead to long - term postoperative renal dysfunction. However, in this study only RLAP patients were included in the study, so no comparison was made with the RRP method (14).…”

Comparison of Acute Kidney Injury After Robot-Assisted Laparoscopic Radical Prostatectomy Versus Retropubic Radical Prostatectomy

“…However, previous studies on this issue have reported that postoperative renal function is unaltered after RALP, even under using a pressure of 20 mm Hg for pneumoperitoneum. 25 , 26 However, these earlier reports analyzed the change in the creatinine clearance or the value of eGFR to measure the differences between preoperative and postoperative renal function, instead of using validated criteria. Also, those studies analyzed only patients that underwent RALP, so the outcomes were not comparable to patients who underwent RRP.…”