Experimental Study of Cardiorespiratory and Stress Factors in Esophageal Surgery Using Robot-Assisted Thoracoscopic or Open Thoracic Approach

Eisold, S.; Mehrabi, Arianeb; Konstantinidis, Lucas; Mieth, Markus; Hinz, Ulf; Kashfi, Arash; Fonouni, Hamidreza; Müller‐Stich, Beat P.; Gebhard, Martha Maria; Schmidt, Jan; Büchler, Markus W.; Gutt, Carsten N.

doi:10.1001/archsurg.2007.56

Cited by 11 publications

(3 citation statements)

References 46 publications

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“…The present study shows that RARP accelerates surgical stress recovery along the neuroendocrine system. Our results are confirmed by an experimental study that compared the stress response to robotic technology during thoracoscopic mobilization and anastomosis of the esophagus vs. the conventional open approach [19] . As a theory, RRP increased the hyper inflammatory response followed by cell-mediated immunosuppression which triggered higher stress levels along the HPA axis ( Fig.…”

Section: Discussionsupporting

confidence: 74%

Robotic assisted radical prostatectomy accelerates postoperative stress recovery: Final results of a contemporary prospective study assessing pathophysiology of cortisol peri-operative kinetics in prostate cancer surgery

Porcaro

Luyk

Corsi

et al. 2016

Asian Journal of Urology

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ObjectiveTo investigate the effects of prostate cancer (PCa) surgery on the stress system and to identify potential independent factors associating with stress recovery.MethodsThe design of the study was prospective and PCa surgery included robot assisted radical prostatectomy (RARP) or retropubic radical prostatectomy (RRP). Between February 2013 to December 2014, 315 consecutive patients were evaluated. The effects of PCa surgery on the stress system were measured by cortisol serum levels before and after surgery on postoperative day (POD) 0, 1, 3, 5 and 45. Cortisol variations in the population and subpopulation (RARP vs. RRP) of patients were investigated by statistical methods. Factors associating with stress recovery were assessed by simple linear regression (SLR) and multiple linear regression (MLR) analysis.ResultsRARP was performed in 75.9% of cases. In the patient population, there were wide serum cortisol perioperative variations. PCa surgery triggered the stress system which immediately (POD 0) responded by cortisol overproduction which induced the negative feedback mechanism that started on POD 1, continued on POD 3, was still ongoing on POD 5 and completely settled on POD 45 (stress recovery). In the subpopulation of patients, significantly lower cortisol serum levels were detected on POD 3–5 in RARP cases in whom cortisol levels were close to preoperative levels (stress recovery) on POD 5. Independent predictive factors of serum cortisol on POD 5 (stress recovery) were preoperative cortisol (p = 0.02), cortisol levels on POD 3 (p < 0.0001) and RARP (p = 0.03) in which the association was negative (stress recovery faster than RRP).ConclusionOur study shows that PCa surgery immediately (POD 0) triggers the stress system which respond by overproduction of cortisol which induces the negative feedback mechanism that starts on POD 1, is still ongoing on POD 5, but is completely settled on POD 45. Moreover, after surgical trauma, our study gives evidence that the RARP procedure associates with stress recovery faster than RRP. Further confirmatory studies are required.

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Section: Discussionsupporting

confidence: 74%

Robotic assisted radical prostatectomy accelerates postoperative stress recovery: Final results of a contemporary prospective study assessing pathophysiology of cortisol peri-operative kinetics in prostate cancer surgery

Porcaro

Luyk

Corsi

et al. 2016

Asian Journal of Urology

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“…Measurement of surgical stress is used in people for evaluation of anesthetic protocols . Similarly, measurement of surgical stress is used for the evaluation of surgical techniques . In 1 study, 2 different approaches for lumbar spine surgery were compared.…”

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confidence: 99%

Intraoperative Changes in Blood Pressure, Heart Rate, Plasma Vasopressin, and Urinary Noradrenalin During Elective Ovariohysterectomy in Dogs: Repeatability at Removal of the 1st and 2nd Ovary

et al. 2014

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“…One experimental study showed that the robot‐assisted thoracic approach was associated with improved intraoperative cardiopulmonary function and less stress compared with the open thoracic approach 41. The study used 12 pigs and evaluated hemodynamics (central venous pressure, pulmonary vascular resistance, cardiac output, and blood gas values), substance P and cortisol levels.…”

Section: Comparison With Conventional Proceduresmentioning

confidence: 99%

Robotic surgery for esophageal cancer: Merits and demerits

Seto

Mori

Aikou

2017

Annals of Gastroent Surgery

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Since the introduction of robotic systems in esophageal surgery in 2000, the number of robotic esophagectomies has been gradually increasing worldwide, although robot‐assisted surgery is not yet regarded as standard treatment for esophageal cancer, because of its high cost and the paucity of high‐level evidence. In 2016, more than 1800 cases were operated with robot assistance. Early results with small series demonstrated feasibility and safety in both robotic transhiatal (THE) and transthoracic esophagectomies (TTE). Some studies report that the learning curve is approximately 20 cases. Following the initial series, operative results of robotic TTE have shown a tendency to improve, and oncological long‐term results are reported to be effective and acceptable: R0 resection approaches 95%, and locoregional recurrence is rare. Several recent studies have demonstrated advantages of robotic esophagectomy in lymphadenectomy compared with the thoracoscopic approach. Such technical innovations as three‐dimensional view, articulated instruments with seven degrees of movement, tremor filter etc. have the potential to outperform any conventional procedures. With the aim of preventing postoperative pulmonary complications without diminishing lymphadenectomy performance, a nontransthoracic radical esophagectomy procedure combining a video‐assisted cervical approach for the upper mediastinum and a robot‐assisted transhiatal approach for the middle and lower mediastinum, transmediastinal esophagectomy, was developed; its short‐term outcomes are promising.Thus, the merits or demerits of robotic surgery in this field remain quite difficult to assess. However, in the near future, the merits will definitely outweigh the demerits because the esophagus is an ideal organ for a robotic approach.

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Experimental Study of Cardiorespiratory and Stress Factors in Esophageal Surgery Using Robot-Assisted Thoracoscopic or Open Thoracic Approach

Abstract: The robot-assisted approach is associated with improved intraoperative cardiopulmonary function and seems to be a less stressful technique.

Cited by 11 publications

References 46 publications

Robotic assisted radical prostatectomy accelerates postoperative stress recovery: Final results of a contemporary prospective study assessing pathophysiology of cortisol peri-operative kinetics in prostate cancer surgery

Robotic assisted radical prostatectomy accelerates postoperative stress recovery: Final results of a contemporary prospective study assessing pathophysiology of cortisol peri-operative kinetics in prostate cancer surgery

Intraoperative Changes in Blood Pressure, Heart Rate, Plasma Vasopressin, and Urinary Noradrenalin During Elective Ovariohysterectomy in Dogs: Repeatability at Removal of the 1st and 2nd Ovary

Robotic surgery for esophageal cancer: Merits and demerits

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