Reduction in postoperative ileus rates utilizing lower pressure pneumoperitoneum in robotic-assisted radical prostatectomy

Rohloff, Matthew; Cicic, Arman; Christensen, Cody; Maatman, Thomas K.; Lindberg, Jeffrey; Maatman, Thomas J.

doi:10.1007/s11701-018-00915-w

Cited by 35 publications

(37 citation statements)

References 9 publications

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“…Findings of previous systematic reviews assessing the effect of a low IAP on perioperative outcomes in patients undergoing laparoscopic surgery were conflicting, either showing a significant reduction in pain scores 23 or no effects 6,24 . Significant decreases in perioperative complications were found in prospective studies 25–27 . Only one study 28 that reported on the quality of recovery found no difference between a low and standard IAP strategy.…”

Section: Discussionmentioning

confidence: 99%

Effect of an individualized versus standard pneumoperitoneum pressure strategy on postoperative recovery: a randomized clinical trial in laparoscopic colorectal surgery

Díaz‐Cambronero

Mazzinari²,

Lorente³

et al. 2020

British Journal of Surgery

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Section: Discussionmentioning

confidence: 99%

Effect of an individualized versus standard pneumoperitoneum pressure strategy on postoperative recovery: a randomized clinical trial in laparoscopic colorectal surgery

Díaz‐Cambronero

Mazzinari²,

Lorente³

et al. 2020

British Journal of Surgery

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“…Recent interventional studies have demonstrated reduction in opioid use through education and prescribing guidelines, but prevention of complications in general may provide another avenue to further reduce reliance on opioids and improve overall quality of care [15,16]. Interventions aimed at reducing complications after RP could include components of patient education to guide expectations, early ambulation with risk stratification for venous thromboembolism, use of multimodal analgesia, decreased pneumoperitoneum for robot‐assisted procedures when feasible, and earlier detection of complications [26,27].…”

Section: Discussionmentioning

confidence: 99%

Complications after open and robot‐assisted radical prostatectomy and association with postoperative opioid use: an analysis of data from the PREVENTER trial

Huang

Becker

et al. 2020

BJU International

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Objective To evaluate perioperative complications for open radical prostatectomy (ORP) and robot‐assisted RP (RARP) for patients enrolled in the PREvention of VENous ThromboEmbolism Following Radical Prostatectomy (PREVENTER; ClinicalTrials.gov Identifier: NCT03006562) trial, to determine predictors and impact on opioid consumption. Patients and Methods A prospective cohort of 500 patients undergoing ORP and RARP was followed to determine rates of complications and opioid use. Complications were classified 30 days after RP using the Clavien–Dindo system. Patient characteristics and outcomes were compared using appropriate statistical tests. Logistic and linear regressions were performed to identify predictors of complications and evaluate the relationship between complications and postoperative opioid use. Results A total of 124 (24.8%) men underwent ORP and 376 (75.2%) RARP, with 418 (83.6%) receiving pelvic lymph node dissection (PLND). While 83 patients (16.6%) had complications, only 19 (3.8%) were major (Clavien–Dindo Grade ≥III), with no differences by surgical approach. PLND (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.25–8.71; P = 0.03) and Stage pT3b (OR 2.76, 95% CI 1.23–6.00;P = 0.01) were the only predictors of complications after controlling for potential confounders. Patients who had complications had greater inpatient (P = 0.02) and outpatient (P = 0.005) opioid use, which persisted after controlling for patient‐reported pain, attending surgeon variation, surgical approach, and undergoing PLND (inpatient β:77.2, 95% CI 17.9–136.5,P = 0.03; and outpatient β:21.9, 95% CI 4.7–39.1,P = 0.01). Conclusion In an analysis of prospectively collected data, overall and major complications rates did not differ by surgical approach. Patients receiving PLND and with Stage pT3b disease had more complications. Complications were independently associated with higher inpatient and outpatient postoperative opioid use.

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“…Laparoscopic surgery can reduce surgical trauma and weaken the immune response compared with open surgery, reducing the time for atulence and shorting the time to resume a soft diet after surgery and decreasing the length of the hospital stay [12 ~ 14]. Visualizing laparoscopic surgery and pneumoperitoneum induction can lead to sympathetic nerve activation [15,16]. In addition, CO 2 pneumoperitoneum can induce hypercarbia, which can directly or indirectly stimulate the sympathetic nervous system and cause evaluated levels of catecholamine [15,17].…”

Section: Discussionmentioning

confidence: 99%

Impact of Intravenous Dexmedetomidine on Postoperative Bowel Movement Recovery After Laparoscopic Nephrectomy: A Consort-Prospective, Randomized, Controlled Trial

Huang

Song

Zhou

et al. 2021

Preprint

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Background Postoperative ileus is a frequent complication after surgery, especially abdominal surgery. Of the factors, sympathetic excitation is the primary factor for postoperative ileus. Sympathetic activation is always increased by the stress of surgery and postoperative pain. It was reported that dexmedetomidine (DEX) lessens pain and inhibits the sympathetic nerve by acting on the locus coeruleus. Therefore we designed our study to observe whether DEX promotes bowel movements in patients after laparoscopic nephrectomy.MethodsOne hundred and twenty patients undergoing laparoscopic nephrectomy were assigned into three groups, group C (normal saline infusion), group D1 (DEX 0.02 µg/kg/h), and group D2 (DEX 0.04 µg/kg/h). The primary outcome was to record the times of first flatus, defecation and eating after surgery. The secondary outcome was postoperative pain accessd by the numerical rating scale (NRS), concerning adverse effects, as well as the duration of the postoperative hospital stay.ResultsThe times of first flatus, defecation and eating in groups D1 and D2 were shorter than those in group C (P<0.01). The NRS scores at 8 h and 24 h after surgery were obviously lower in groups D1 and D2 than in group C (P<0.05). There were no concerning adverse effects (P>0.05).ConclusionDEX in 0.04 µg/kg/h postoperative infusion facilitates bowel movements in patients undergoing laparoscopic nephrectomy.Trial registrationThis trial was registered in a Chinese Clinical Trial Registry (ChiCTR) center on December 23, 2015. The registered number was ChiCTR-IPR-15007628.

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Reduction in postoperative ileus rates utilizing lower pressure pneumoperitoneum in robotic-assisted radical prostatectomy

Cited by 35 publications

References 9 publications

Effect of an individualized versus standard pneumoperitoneum pressure strategy on postoperative recovery: a randomized clinical trial in laparoscopic colorectal surgery

Effect of an individualized versus standard pneumoperitoneum pressure strategy on postoperative recovery: a randomized clinical trial in laparoscopic colorectal surgery

Complications after open and robot‐assisted radical prostatectomy and association with postoperative opioid use: an analysis of data from the PREVENTER trial

Impact of Intravenous Dexmedetomidine on Postoperative Bowel Movement Recovery After Laparoscopic Nephrectomy: A Consort-Prospective, Randomized, Controlled Trial

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