Quantifying and Statistically Modeling Residual Pneumoperitoneum after Robotic-Assisted Laparoscopic Prostatectomy: A Prospective, Single-Center, Observational Study
Background: Laparoscopic surgery (LS) requires CO<sub>2</sub> insufflation to establish the operative field. Patients with worsening pain post-operatively often undergo computed tomography (CT). CT is highly sensitive in detecting free air—the hallmark sign of a bowel injury. Yet, the cl...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
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MDPI AG
2022-03-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/12/4/785 |
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| author | Venkat M. Ramakrishnan Tilo Niemann Philipp Maletzki Edward Guenther Teodora Bujaroska Olanrewaju Labulo Zhufeng Li Juliette Slieker Rahel A. Kubik-Huch Kurt Lehmann Antonio Nocito Lukas J. Hefermehl |
| author_facet | Venkat M. Ramakrishnan Tilo Niemann Philipp Maletzki Edward Guenther Teodora Bujaroska Olanrewaju Labulo Zhufeng Li Juliette Slieker Rahel A. Kubik-Huch Kurt Lehmann Antonio Nocito Lukas J. Hefermehl |
| author_sort | Venkat M. Ramakrishnan |
| collection | DOAJ |
| description | Background: Laparoscopic surgery (LS) requires CO<sub>2</sub> insufflation to establish the operative field. Patients with worsening pain post-operatively often undergo computed tomography (CT). CT is highly sensitive in detecting free air—the hallmark sign of a bowel injury. Yet, the clinical significance of free air is often confounded by residual CO<sub>2</sub> and is not usually due to a visceral injury. The aim of this study was to attempt to quantify the residual pneumoperitoneum (RPP) after a robotic-assisted laparoscopic prostatectomy (RALP). Methods: We prospectively enrolled patients who underwent RALP between August 2018 and January 2020. CT scans were performed on postoperative days (POD) 3, 5, and 7. To investigate potential factors influencing the quantity of RPP, correlation plots were made against common variables. Results: In total, 31 patients with a mean age of 66 years (median 67, IQR 62–70.5) and mean BMI 26.59 (median 25.99, IQR: 24.06–29.24) underwent RALP during the study period. All patients had a relatively unremarkable post-operative course (30/31 with Clavien–Dindo class 0; 1/31 with class 2). After 3, 5, and 7 days, 3.2%, 6.4%, and 32.3% were completely without RPP, respectively. The mean RPP at 3 days was 37.6 mL (median 9.58 mL, max 247 mL, IQR 3.92–31.82 mL), whereas the mean RPP at 5 days was 19.85 mL (median 1.36 mL, max 220.77 mL, IQR 0.19–5.61 mL), and 7 days was 10.08 mL (median 0.09 mL, max 112.42 mL, IQR 0–1.5 mL). There was a significant correlation between RPP and obesity (<i>p</i> = 0.04665), in which higher BMIs resulted in lower initial insufflation volumes and lower RPP. Conclusions: This is the first study to systematically assess RPP after a standardized laparoscopic procedure using CT. Larger patients tend to have smaller residuals. Our data may help surgeons interpreting post-operative CTs in similar patient populations. |
| first_indexed | 2024-03-09T10:58:04Z |
| format | Article |
| id | doaj.art-4c4f674b1a154452a52651970c68ee78 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-09T10:58:04Z |
| publishDate | 2022-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-4c4f674b1a154452a52651970c68ee782023-12-01T01:29:16ZengMDPI AGDiagnostics2075-44182022-03-0112478510.3390/diagnostics12040785Quantifying and Statistically Modeling Residual Pneumoperitoneum after Robotic-Assisted Laparoscopic Prostatectomy: A Prospective, Single-Center, Observational StudyVenkat M. Ramakrishnan0Tilo Niemann1Philipp Maletzki2Edward Guenther3Teodora Bujaroska4Olanrewaju Labulo5Zhufeng Li6Juliette Slieker7Rahel A. Kubik-Huch8Kurt Lehmann9Antonio Nocito10Lukas J. Hefermehl11Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USAInstitute of Radiology, Kantonsspital Baden, 5404 Baden, SwitzerlandDivision of Urology, Kantonsspital Baden, 5404 Baden, SwitzerlandDepartment of Mathematics, Swiss Federal Institute of Technology, 8092 Zurich, SwitzerlandDepartment of Mathematics, Swiss Federal Institute of Technology, 8092 Zurich, SwitzerlandDepartment of Mathematics, Swiss Federal Institute of Technology, 8092 Zurich, SwitzerlandDepartment of Mathematics, Swiss Federal Institute of Technology, 8092 Zurich, SwitzerlandDepartment of Surgery, Kantonsspital Baden, 5404 Baden, SwitzerlandInstitute of Radiology, Kantonsspital Baden, 5404 Baden, SwitzerlandDivision of Urology, Kantonsspital Baden, 5404 Baden, SwitzerlandDepartment of Surgery, Kantonsspital Baden, 5404 Baden, SwitzerlandDivision of Urology, Kantonsspital Baden, 5404 Baden, SwitzerlandBackground: Laparoscopic surgery (LS) requires CO<sub>2</sub> insufflation to establish the operative field. Patients with worsening pain post-operatively often undergo computed tomography (CT). CT is highly sensitive in detecting free air—the hallmark sign of a bowel injury. Yet, the clinical significance of free air is often confounded by residual CO<sub>2</sub> and is not usually due to a visceral injury. The aim of this study was to attempt to quantify the residual pneumoperitoneum (RPP) after a robotic-assisted laparoscopic prostatectomy (RALP). Methods: We prospectively enrolled patients who underwent RALP between August 2018 and January 2020. CT scans were performed on postoperative days (POD) 3, 5, and 7. To investigate potential factors influencing the quantity of RPP, correlation plots were made against common variables. Results: In total, 31 patients with a mean age of 66 years (median 67, IQR 62–70.5) and mean BMI 26.59 (median 25.99, IQR: 24.06–29.24) underwent RALP during the study period. All patients had a relatively unremarkable post-operative course (30/31 with Clavien–Dindo class 0; 1/31 with class 2). After 3, 5, and 7 days, 3.2%, 6.4%, and 32.3% were completely without RPP, respectively. The mean RPP at 3 days was 37.6 mL (median 9.58 mL, max 247 mL, IQR 3.92–31.82 mL), whereas the mean RPP at 5 days was 19.85 mL (median 1.36 mL, max 220.77 mL, IQR 0.19–5.61 mL), and 7 days was 10.08 mL (median 0.09 mL, max 112.42 mL, IQR 0–1.5 mL). There was a significant correlation between RPP and obesity (<i>p</i> = 0.04665), in which higher BMIs resulted in lower initial insufflation volumes and lower RPP. Conclusions: This is the first study to systematically assess RPP after a standardized laparoscopic procedure using CT. Larger patients tend to have smaller residuals. Our data may help surgeons interpreting post-operative CTs in similar patient populations.https://www.mdpi.com/2075-4418/12/4/785residual pneumoperitoneumlaparoscopyprostatectomyX-ray computedrobotic surgical procedurescarbon dioxide |
| spellingShingle | Venkat M. Ramakrishnan Tilo Niemann Philipp Maletzki Edward Guenther Teodora Bujaroska Olanrewaju Labulo Zhufeng Li Juliette Slieker Rahel A. Kubik-Huch Kurt Lehmann Antonio Nocito Lukas J. Hefermehl Quantifying and Statistically Modeling Residual Pneumoperitoneum after Robotic-Assisted Laparoscopic Prostatectomy: A Prospective, Single-Center, Observational Study Diagnostics residual pneumoperitoneum laparoscopy prostatectomy X-ray computed robotic surgical procedures carbon dioxide |
| title | Quantifying and Statistically Modeling Residual Pneumoperitoneum after Robotic-Assisted Laparoscopic Prostatectomy: A Prospective, Single-Center, Observational Study |
| title_full | Quantifying and Statistically Modeling Residual Pneumoperitoneum after Robotic-Assisted Laparoscopic Prostatectomy: A Prospective, Single-Center, Observational Study |
| title_fullStr | Quantifying and Statistically Modeling Residual Pneumoperitoneum after Robotic-Assisted Laparoscopic Prostatectomy: A Prospective, Single-Center, Observational Study |
| title_full_unstemmed | Quantifying and Statistically Modeling Residual Pneumoperitoneum after Robotic-Assisted Laparoscopic Prostatectomy: A Prospective, Single-Center, Observational Study |
| title_short | Quantifying and Statistically Modeling Residual Pneumoperitoneum after Robotic-Assisted Laparoscopic Prostatectomy: A Prospective, Single-Center, Observational Study |
| title_sort | quantifying and statistically modeling residual pneumoperitoneum after robotic assisted laparoscopic prostatectomy a prospective single center observational study |
| topic | residual pneumoperitoneum laparoscopy prostatectomy X-ray computed robotic surgical procedures carbon dioxide |
| url | https://www.mdpi.com/2075-4418/12/4/785 |
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