Serum cytokine levels as markers of paralytic ileus following robotic radical prostatectomy at different pneumoperitoneum pressures

Abstract

Background: To evaluate intraoperative and postoperative cytokines in patients who underwent robotic prostatectomy (RP) at a pressure of 12 or 15 mm Hg, and the risk of postoperative ileus. Materials and methods: We presented the first series evaluating intraoperative and postoperative cytokines in patients undergoing RP at a pressure of 12 or 15 mm Hg by a single surgeon. Changes in cytokine concentrations were shown to correlate with surgical outcomes and pathological states. The study investigated the changes in cytokine concentrations (interferon-γ, tumor necrosis factor-α, interleukin-1β [IL-1β], IL-2, IL-4, IL-6, IL-12, and IL-17) at different pneumoperitoneum pressures and their potential role in the development of postoperative ileus. Results: The data on 10 consecutive patients confirmed that a lower pneumoperitoneum pressure was associated with lower cytokine levels and a lower risk of ileus. There were increased levels of postoperative interferon-γ, tumor necrosis factor-α, IL-12p70, IL-1β, IL-2, IL-4, and IL-17a at 15 mm Hg when compared to 12 mm Hg. Conclusions: The data indicated that lower pressure RP reduced intra-/postoperative cytokine levels confirming our hypothesis. Larger patient numbers are required to further validate this but the implications of this data will benefit not only urological patients but also other speciality patients undergoing minimally invasive surgery.

Comparing different pneumoperitoneum (12 vs. 15 mmHg) pressures with cytokine analysis to evaluate clinical outcomes in patients undergoing robotic‐assisted laparoscopic radical cystectomy and intracorporeal robotic urinary diversion

“…We also found that lower pressures were associated with reduced rates of ileus, and furthermore, this was associated with alterations in postoperative cytokine levels favouring an anti-inflammatory response. 22 The latter has not been explicitly confirmed in the current study, with the medians for IL-1β, IL-2, IL-17A, TNFα and IFNγ showing no statistically significant differences between pressures or study groups.…”

Randomized Trial of Ultralow vs Standard Pneumoperitoneum during Robotic Prostatectomy

“…8 Hampson et al studied cytokine levels in 10 RP patients at 15 mmHg vs 12 mmHg and found lower levels of cytokines associated with a risk of ileus but without any clinical differences in outcomes. 13 We previously performed a retrospective study of 300 patients in each group after switching from a routine of 15 mmHg to 6 mmHg and found a modest improvement in pain with no increase in complications or other negative impact. 14 We therefore designed the current randomized study to carefully measure pain scores and analgesic use as well as physiological measures and other clinically meaningful perioperative RP outcomes.…”

“…8 Hampson et al studied cytokine levels in 10 RP patients at 15 mmHg vs 12 mmHg and found lower levels of cytokines associated with a risk of ileus but without any clinical differences in outcomes. 13…”

“…While a few previous studies have evaluated some physiological and clinical measures of RP performed at 8 mmHg or 12 mmHg, none has yet demonstrated benefits that would motivate a change in standard practice. 8,9,11–13 We hypothesized that using an ultralow pneumoperitoneum pressure of 6 mmHg during RP as compared with the typical pressure of 15 mmHg might identify benefits in pain and physiological parameters based upon the encouraging findings from our retrospective study comparing 2 groups of 300 patients each. 14 We therefore performed a randomized, double-blinded study comparing RP at 6 mmHg with 15 mmHg, and rigorously tracked pain and analgesic use as well other outcomes to determine whether low pressure is advantageous in RP.…”

The Impact of intra-abdominal Pressure on Perioperative Outcomes in Robotic-Assisted Radical Prostatectomy: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

“…Available evidence from currently published studies that can inform clinical practice includes a retrospective study in 2018 [16] and two randomized controlled trials (RCTs) published in 2020 [17] and 2021 [18]. Tese studies suggest that low IAP during RARP is associated with a signifcant reduction in the incidence of postoperative bowel obstruction compared with standard IAP [16][17][18]. However, the impact of low IAP on operative time, length of hospital stay, and other surgical outcomes is unknown.…”