Independent Predicting Factors for Subcutaneous Emphysema Associated with Robotic-Assisted Laparoscopic Radical Prostatectomy: A Retrospective Single-Center Study

Abstract

Objectives: Subcutaneous emphysema (SCE) is a complication associated with laparoscopic surgery. Severe SCE complicated by excessive hypercarbia may afford detrimental effects in surgical patients with cardiac dysfunction. Robotic-assisted laparoscopic radical prostatectomy (RALP) has several predisposing factors that contribute to SCE. The main purpose of our single-center retrospective study was to determine the preoperative and intraoperative predicting factors for SCE associated with RALP and to determine the actual incidence of SCE. Methods: In total, 229 adult male patients underwent standardized RALP for prostate cancer over the period of 1 May 2016 to 31 October 2018 at the Ehime University Hospital. We reviewed electronic clinical records for individual characteristics including age, body weight, height, coexisting disorders, preoperative ASA physical status, and the length of postoperative hospital stay. We also reviewed surgical and anesthetic records for the operation time, anesthetic method, and the partial pressure of end-tidal CO2 (PetCO2) during RALP. To determine the presence of SCE, we examined supine chest X-rays obtained after the completion of surgery. Results: We found 55 cases (24.0%) of SCE. Multiple logistic regression analysis showed that a BMI < 25 kg/m2 (OR: 3.0, 95% CI: 1.25–7.26) and a maximum value of PetCO2 of 46 mmHg or greater (OR: 23.3, 95% CI: 8.22–66.1) were independent predicting factors for SCE. Conclusion: These two predicting factors may be helpful to recognize the occurrence of SCE. Anesthesiologists should protect against SCE progression with the earlier detection of SCE for safe anesthetic management in patients undergoing RALP.

Upper extremity contact pressure measurement in robot-assisted pelvic surgery

“…In the Trendelenburg position, body fluid moves from the legs toward the heart by gravitational displacement due to body inversion [ 13 ]. In addition, the RARP procedure can cause subcutaneous emphysema around the neck [ 14 ]. Moreover, the cephalad move of the patient occurs due to the Trendelenburg position in RAPS [ 15 ].…”

The intraoperative management of robotic-assisted laparoscopic prostatectomy

“…Robotic-assisted laparoscopic radical prostatectomy procedure, because of the presence of multiple surgical ports, prolonged surgery duration and its peculiar position, can favor the development of subcutaneous emphysema. Yamamoto et al [6 ▪ ] found the presence of subcutaneous emphysema in 24% of the patients who underwent chest X-rays. Nevertheless, none of these patients showed any postoperative pulmonary complications, such as loss of upper airway patency or respiratory failure.…”

Tips for set-up to prevent complications in robotic gynecologic cancer surgery

“…Extrapolating the experience from laparoscopic surgery, risk factors for SCE include multiple abdominal entries, long operative times of ≥200 minutes, five or more laparoscopic ports, and age older than 65 years [17,18]. A retrospective of robotic prostatectomy showed that BMI <25 kg/m 2 and partial pressure of endtidal CO 2 of ≥ 46 mmHg were two independent factors for SCE [19]. SCE can lead to laryngeal edema, tracheal compression, and subsequently hypercarbia and respiratory acidosis [17].…”

“…SCE can lead to laryngeal edema, tracheal compression, and subsequently hypercarbia and respiratory acidosis [17]. The treatment of hypercarbia by increasing pulmonary ventilation, however, is limited by Trendelenburg position and pneumoperitoneum [19].…”