Examining clinical outcomes utilizing low-pressure pneumoperitoneum during robotic-assisted radical prostatectomy

Christensen, Cody; Maatman, Thomas K.; Tran, Tony

doi:10.1007/s11701-016-0570-3

Cited by 18 publications

(20 citation statements)

References 8 publications

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“…Christensen and colleagues compared a pressure of 12 mmHg versus 15 mmHg, following a retrospective review of their single surgeon prostatectomy database from 2012 to 2015 [ 7 ]. 100 patients who had prostatectomy at 15 mmHg and then 100 who had prostatectomy at 12 mmHg.…”

Section: Resultsmentioning

confidence: 99%

“…Rohloff and colleagues performed a retrospective review of 400 patients undergoing prostatectomy over a 5-year period. A single surgeon (the same as in the Christensen et al paper [ 7 ]) performed 209 successful prostatectomies at 15 mmHg of which, 202 were included in the study [ 8 ]. The same surgeon then changed practice and performed the remaining 198 prostatectomies at 12 mmHg which were included as the second arm of the study.…”

Section: Resultsmentioning

confidence: 99%

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Clinical outcomes of low-pressure pneumoperitoneum in minimally invasive urological surgery

et al. 2022

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The adoption of minimally invasive laparoscopic techniques has revolutionised urological practice. This necessitates a pneumoperitoneum (PNP) and the impact the PNP pressure has on post-operative outcomes is uncertain. During the current COVID-19 era guidance has suggested the utilisation of lower PNP pressures to mitigate the risk of intra-operative viral transmission. Review the current literature regarding the impact of pneumoperitoneum pressure, within the field of urology, on post-operative outcomes. A search of the PubMed, Medline and EMBASE databases was undertaken to identify studies that met the inclusion criteria. The Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines were adhered to. Ten studies, that included both randomised controlled trials and retrospective case series reviews, were identified that met the inclusion criteria. The effect of PNP pressure on outcomes following prostatectomy, live donor nephrectomy, partial nephrectomy and a variety of benign upper tract procedures were discussed. Low pressure PNP appears safe when compared to high pressure PNP, potentially reducing post-operative pain and rates of ileus. When compared to general surgery, there is a lack of quality evidence investigating the impact of PNP pressures on outcomes within urology. Low pressure PNP appears non-inferior to high pressure PNP. More research is required to validate this finding, particularly post-cystectomy and nephrectomy.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Clinical outcomes of low-pressure pneumoperitoneum in minimally invasive urological surgery

et al. 2022

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“…Christensen et al. compared postoperative outcomes of 200 RALP procedures (100 performed at a standard pressure of 15 mmHg and 100 at a pressure of 12 mmHg), finding no significant differences in LOS or complications. La Falce et al.…”

Section: Discussionmentioning

confidence: 99%

“…Christensen et al [15] compared postoperative outcomes of 200 RALP procedures (100 performed at a standard pressure of 15 mmHg and 100 at a pressure of 12 mmHg), finding no significant differences in LOS or complications. La Falce et al [7] performed 53 RALP procedures at 8 mmHg and found improvements in multiple intra-operative cardiovascular variables but did not assess postoperative outcomes such as pain scores and LOS.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of robot‐assisted prostatectomy performed at ultra‐low pneumoperitoneum pressure of 6 mmHg and comparison of clinical outcomes vs standard pressure of 15 mmHg

Ferroni

Abaza

2019

BJU International

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Objectives To evaluate the feasibility of performing robot‐assisted laparoscopic prostatectomy (RALP) at an ultra‐low pressure of 6 mmHg and to assess the potential impact on its clinical outcomes, as compared to those of a historical cohort of patients in which RALP was performed at a pressure of 15 mmHg. Patients and Methods We evaluated 600 consecutive RALP procedures, performed by a single surgeon, including 300 procedures performed at 6 mmHg and the previous 300 performed at 15 mmHg. We compared preoperative patient characteristics and outcomes including pain scores, morphine equivalents, length of stay (LOS) and complications. After implementing the adjustment to 6 mmHg, we began allowing same‐day discharge in patients meeting established criteria. Results All 300 consecutive RALP procedures were completed at 6 mmHg with no pressure adjustments for the entirety of the case. There were no significant differences in patient or pathological features between groups. Body mass index was 19.5–44.3 kg/m2 in the 6 mmHg group. The mean operating time was 10.5‐min longer and mean estimated blood loss 20‐mL higher at 6 mmHg, with no blood transfusions in either group. The mean LOS was shorter in the 6‐mmHg group (0.57 vs 1.00 days; P < 0.001), with 43.3% of patients in the 6‐mmHg group discharged home the day of surgery. There were no differences in morphine equivalents or maximum pain scores in the first 4 h after surgery, but there was a small improvement (18%) in pain scores at 5–12 h postoperatively (3.2 vs 3.9; P < 0.001). The 30‐day complication rate was 8.7% vs 4.0%, with 30‐day hospital readmissions of 5.7% vs 1.0% for the 15 vs 6 mmHg groups. Conclusion Robot‐assisted laparoscopic prostatectomy at a pneumoperitoneum pressure of 6 mmHg was uniformly feasible without increasing complications. Ultra‐low pneumoperitoneum may confer a pain benefit, which may contribute to safe same‐day discharge.

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“…[4] Postoperative ileus is caused by many factors, the most important of which is the preferred surgical technique. Christensen et al [17] divided their patients into two groups and performed robotic radical prostatectomy by applying the 12 mmHg pressure in one group and 15 mmHg in the other. Postoperative ileus was detected in 4% of the low pressure group, whereas it was detected in 8% of the other group.…”

Section: Discussionmentioning

confidence: 99%

Robotic-assisted perineal versus transperitoneal radical prostatectomy: A matched-pair analysis

Tuğcu

Akça²,

Şimşek

et al. 2019

Turkish Journal of Urology

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Objective: We compared the outcomes of robotic-assisted radical perineal prostatectomy (r-PRP) versus robotic-assisted transperitoneal laparoscopic radical prostatectomy (RARP). Material and methods:Between November 2016 and September 2017 in our center, 40 patients underwent r-PRP, and 40 patients underwent RARP. All patients also underwent multiparametric magnetic resonance imaging (mpMRI) to exclude the cases with locally advanced disease. Patients with localized prostate cancer (C-T2N0M0) were included in the study. The exclusion criteria were contraindications for undergoing robotic radical prostatectomy; the Gleason score ≥4+3; extracapsular extension proven on biopsy or suspected on mpMRI; clinical stage ≥T2c; required pelvic lymph dissection according to Partin's normogram; previous radiation therapy; hormonal therapy; any previous prostatic, urethral, or bladder neck surgery; and preoperative urinary incontinence or erectile dysfunction. Patients were placed in the exaggerated lithotomy position with 15° Trendelenburg for r-PRP and 40° Trendelenburg for RARP. Results:The mean age for the r-PRP and RARP groups were 61.2 (46-73) and 62.2 (50-75) years, respectively. The mean body mass index was significantly higher in the r-PRP group (p= 0.02). The mean procedure duration time was 169.4 (100-255) minutes for the r-PRP group and 173.1 (130-210) minutes for the RARP group. The mean console time and anastomosis time were significantly lower for the r-PRP group. The mean estimated blood loss was significantly lower for the r-PRP group (p= 0.002). Immediate continence rates in the r-PRP and RARP groups following the urethral catheter removal were 42% and 35% (p= 0.30), respectively. Continence rates increased to 94.2% in the r-PRP and 72% in RARP (p= 0.001) group at the 6 th month, and to 95% in the r-PRP and 85.2% in RARP (p= 0.02) group at the 9th month follow-up period. According to the International Index of Erectile Function-5 (IIEF-5), the erectile function rates at the 3-, 6-, and 9-month follow-up in the r-PRP group were 44%, 66%, and 75%, respectively. The rates in the RARP group at the 3-, 6-, and 9-month follow-up were 25%, 42%, and 66% (p= 0.001), respectively. Conclusion:In our experience, r-PRP has acceptable morbidity, excellent surgical and pathological outcomes, and satisfactory oncologic and functional results compared to RARP.

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Examining clinical outcomes utilizing low-pressure pneumoperitoneum during robotic-assisted radical prostatectomy

Cited by 18 publications

References 8 publications

Clinical outcomes of low-pressure pneumoperitoneum in minimally invasive urological surgery

Clinical outcomes of low-pressure pneumoperitoneum in minimally invasive urological surgery

Feasibility of robot‐assisted prostatectomy performed at ultra‐low pneumoperitoneum pressure of 6 mmHg and comparison of clinical outcomes vs standard pressure of 15 mmHg

Robotic-assisted perineal versus transperitoneal radical prostatectomy: A matched-pair analysis

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