Pronounced haemodynamic changes during and after robotic-assisted laparoscopic prostatectomy: a prospective observational study

Abstract

ObjectivesRobotic-assisted laparoscopic prostatectomy (RALP) is typically conducted in steep Trendelenburg position (STP). This study investigated the influence of permanent 45° STP and capnoperitoneum on haemodynamic parameters during and after RALP.DesignProspective observational study.SettingHaemodynamic changes were recorded with transpulmonary thermodilution and pulse contour analysis in men undergoing RALP under standardised anaesthesia.ParticipantsInformed consent was obtained from 51 patients scheduled for elective RALP in a University Medical Centre in Germany.InterventionsHeart rate, mean arterial pressure, central venous pressure (CVP), Cardiac Index (CI), systemic vascular resistance (SVR), Global End-Diastolic Volume Index (GEDI), global ejection fraction (GEF), Cardiac Power Index (CPI) and stroke volume variation (SVV) were recorded at six time points: 20 min after induction of anaesthesia (T1), after insufflation of capnoperitoneum in supine position (T2), after 30 min in STP (T3), when controlling Santorini’s plexus in STP (T4), before awakening in supine position (T5) and after 45 min in the recovery room (T6). Adverse cardiac events were registered intraoperatively and postoperatively.ResultsAll haemodynamic parameters were significantly changed by capnoperitoneum and STP during RALP and partly normalised at T6. CI, GEF and CPI were highest at T6 (CI: 3.9 vs 2.2 L/min/m²; GEF: 26 vs 22%; CPI: 0.80 vs 0.39 W/m²; p<0.001). CVP was highest at T4 (31 vs 7 mm Hg, p<0.001) and GEDI at T6 (819 vs 724 mL/m², p=0.005). Mean SVR initially increased (T2) but had decreased by 24% at T6 (p<0.001). SVV was highest at T5 (12 vs 9%, p<0.001). Two of the patients developed cardiac arrhythmia during RALP and one patient suffered postoperative cardiac ischaemia.ConclusionsRALP led to pronounced perioperative haemodynamic changes. The combination of increased cardiac contractility and heart rate reflects a hyperdynamic situation during and after RALP. Anaesthesiologists should be aware of unnoticed pre-existing heart failure to worsen during STP in patients undergoing RALP.

Prediction of hypotension after postural change in robot-assisted laparoscopic prostatectomy using esophageal Doppler monitoring: a prospective observational trial

“…Laparoscopic surgery with CO 2 insufflation produces considerable hemodynamic changes 11 . In addition to CO 2 pneumoperitoneum, the steep Trendelenburg position is also used during RALP; these conditions result in more pronounced hemodynamic changes 3 – 5 . The Trendelenburg position induces an increase in the MAP, whereas resuming the supine position leads to a decrease in the MAP 3 – 5 .…”

“…Robot-assisted laparoscopic prostatectomy (RALP) has become a more favorable surgical technique than open prostatectomy based on postoperative complications, perioperative outcomes, and functional outcomes 1 , 2 . However, a specific physiologic condition is required for RALP: pneumoperitoneum with carbon dioxide (CO 2 ) insufflation and a steep Trendelenburg position of ≥ 30° 3 – 5 . These combined effects can result in considerable hemodynamic alterations, including > 30% increase in the mean arterial pressure (MAP) and a threefold increase in the central venous pressure (CVP) 3 , 4 .…”

“…These combined effects can result in considerable hemodynamic alterations, including > 30% increase in the mean arterial pressure (MAP) and a threefold increase in the central venous pressure (CVP) 3 , 4 . Furthermore, resuming a supine position with cessation of CO 2 insufflation afterward induces considerable abrupt decreases in the MAP and CVP 4 , 5 .…”

Uroonkologische Therapie in der ersten Welle der COVID-19-Pandemie

“…Prinzipiell könnte folglich eine abgelaufene COVID-19-Erkrankung ein negativer Faktor für folgende Operationen aufgrund potenzieller kardiopulmonaler Belastungen sein [ 3 ]. Dies könnte unter anderem bei robotisch assistierten Eingriffen relevant sein; eine prospektive Regensburger Studie beschreibt bei 50 unselektierten Patienten signifikante hämodynamische Veränderungen, die jedoch ohne erkennbare klinische Relevanz blieben [ 15 ]. Bei Post-COVID-19-Patienten könnte dies aufgrund der zusätzlichen Veränderungen anders sein.…”

“…2) Ist umgekehrt eine COVID-19-Erkrankung vor einer uroonkologischen Operation ein Risikofaktor für Komplikationen? Es finden sich zu diesen beiden Fragestellungen bisher nur sehr wenige Referenzen in der Literatur [8][9][10][11][12][13][14][15][16].…”