Moderate Intra-Abdominal Pressure Levels in Robot-Assisted Radical Prostatectomy Seem to Have No Negative Impact on Clinical Outcomes
<b>Introduction:</b> Radical prostatectomy is increasingly performed laparoscopically with robot assistance (RALRP). RALRP, as with all laparoscopic procedures, requires a pneumoperitoneum, which might result in peritoneal inflammatory response reactions and postoperative pain. The aim o...
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| Format: | Article |
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MDPI AG
2024-02-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/13/5/1202 |
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| author | Angelo Ippolito Jan Mulier Marta Hahn Mike Wenzel Philipp Mandel Armin N. Flinspach Katharina J. Wenger |
| author_facet | Angelo Ippolito Jan Mulier Marta Hahn Mike Wenzel Philipp Mandel Armin N. Flinspach Katharina J. Wenger |
| author_sort | Angelo Ippolito |
| collection | DOAJ |
| description | <b>Introduction:</b> Radical prostatectomy is increasingly performed laparoscopically with robot assistance (RALRP). RALRP, as with all laparoscopic procedures, requires a pneumoperitoneum, which might result in peritoneal inflammatory response reactions and postoperative pain. The aim of this retrospective single-centre study was to analyse the effects of a pneumoperitoneum during RARLP on clinical outcomes. <b>Methods:</b> All patients who underwent robot-guided prostatectomy in our clinic were included, with the exception of patients who were converted to open prostatectomy. C-reactive protein was used as a marker for the primary outcome, namely the postoperative inflammatory response. Intra-abdominal pressure (IAP) was evaluated as a potential factor influencing inflammation. In addition, the waist–hip ratio was used to estimate the amount of visceral adipose tissue, and the administration of dexamethasone was considered as a factor influencing inflammation. The Visual Analogue Scale (VAS) was used to determine postoperative pain. Patients were consecutively recruited between 1 September 2020 and 31 March 2022. <b>Results:</b> A total of 135 consecutive patients were included. The median waist–hip ratio was 0.55. The median duration of the pneumoperitoneum was 143 min. The median values of the average and maximum IAP values were 10 mmHg and 15 mmHg, respectively. The mean CRP of the first postoperative day was 6.2 mg/dL. The median VAS pain level decreased from 2 to 1 from the first to the third postoperative day. On the first postoperative day, 16 patients complained of shoulder pain. In addition, 134 patients were given some form of opioid pain treatment following surgery. <b>Conclusion:</b> We could not identify any relevant associations between the duration and IAP of the pneumoperitoneum and the indirect markers of inflammation or indicators of pain, or between the latter and the amount of visceral adipose tissue. In addition, we found no significant effect of the administration of dexamethasone on postoperative inflammation. The results point to a noninferior tolerability of moderate pressure during the procedure compared to the commonly utilised higher pressure, yet this must be confirmed in randomised controlled trials. |
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| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-04-25T00:26:50Z |
| publishDate | 2024-02-01 |
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| spelling | doaj.art-9b5bca6d0f0941d49bf7a95291da10912024-03-12T16:47:33ZengMDPI AGJournal of Clinical Medicine2077-03832024-02-01135120210.3390/jcm13051202Moderate Intra-Abdominal Pressure Levels in Robot-Assisted Radical Prostatectomy Seem to Have No Negative Impact on Clinical OutcomesAngelo Ippolito0Jan Mulier1Marta Hahn2Mike Wenzel3Philipp Mandel4Armin N. Flinspach5Katharina J. Wenger6Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, GermanyDepartment of Anaesthesiology, Intensive Care and Reanimation, AZ Sint Jan Brugge, 8000 Bruges, BelgiumDepartment of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, GermanyDepartment of Urology, University Hospital Frankfurt, Goethe-University Frankfurt, 60590 Frankfurt am Main, GermanyDepartment of Urology, University Hospital Frankfurt, Goethe-University Frankfurt, 60590 Frankfurt am Main, GermanyDepartment of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, GermanyInstitute of Neuroradiology, University Hospital Frankfurt, Goethe-University Frankfurt, 60528 Frankfurt am Main, Germany<b>Introduction:</b> Radical prostatectomy is increasingly performed laparoscopically with robot assistance (RALRP). RALRP, as with all laparoscopic procedures, requires a pneumoperitoneum, which might result in peritoneal inflammatory response reactions and postoperative pain. The aim of this retrospective single-centre study was to analyse the effects of a pneumoperitoneum during RARLP on clinical outcomes. <b>Methods:</b> All patients who underwent robot-guided prostatectomy in our clinic were included, with the exception of patients who were converted to open prostatectomy. C-reactive protein was used as a marker for the primary outcome, namely the postoperative inflammatory response. Intra-abdominal pressure (IAP) was evaluated as a potential factor influencing inflammation. In addition, the waist–hip ratio was used to estimate the amount of visceral adipose tissue, and the administration of dexamethasone was considered as a factor influencing inflammation. The Visual Analogue Scale (VAS) was used to determine postoperative pain. Patients were consecutively recruited between 1 September 2020 and 31 March 2022. <b>Results:</b> A total of 135 consecutive patients were included. The median waist–hip ratio was 0.55. The median duration of the pneumoperitoneum was 143 min. The median values of the average and maximum IAP values were 10 mmHg and 15 mmHg, respectively. The mean CRP of the first postoperative day was 6.2 mg/dL. The median VAS pain level decreased from 2 to 1 from the first to the third postoperative day. On the first postoperative day, 16 patients complained of shoulder pain. In addition, 134 patients were given some form of opioid pain treatment following surgery. <b>Conclusion:</b> We could not identify any relevant associations between the duration and IAP of the pneumoperitoneum and the indirect markers of inflammation or indicators of pain, or between the latter and the amount of visceral adipose tissue. In addition, we found no significant effect of the administration of dexamethasone on postoperative inflammation. The results point to a noninferior tolerability of moderate pressure during the procedure compared to the commonly utilised higher pressure, yet this must be confirmed in randomised controlled trials.https://www.mdpi.com/2077-0383/13/5/1202robot-assisted radical prostatectomylaparoscopypneumoperitoneumintraabdominal pressurepostoperative inflammationpostoperative pain |
| spellingShingle | Angelo Ippolito Jan Mulier Marta Hahn Mike Wenzel Philipp Mandel Armin N. Flinspach Katharina J. Wenger Moderate Intra-Abdominal Pressure Levels in Robot-Assisted Radical Prostatectomy Seem to Have No Negative Impact on Clinical Outcomes Journal of Clinical Medicine robot-assisted radical prostatectomy laparoscopy pneumoperitoneum intraabdominal pressure postoperative inflammation postoperative pain |
| title | Moderate Intra-Abdominal Pressure Levels in Robot-Assisted Radical Prostatectomy Seem to Have No Negative Impact on Clinical Outcomes |
| title_full | Moderate Intra-Abdominal Pressure Levels in Robot-Assisted Radical Prostatectomy Seem to Have No Negative Impact on Clinical Outcomes |
| title_fullStr | Moderate Intra-Abdominal Pressure Levels in Robot-Assisted Radical Prostatectomy Seem to Have No Negative Impact on Clinical Outcomes |
| title_full_unstemmed | Moderate Intra-Abdominal Pressure Levels in Robot-Assisted Radical Prostatectomy Seem to Have No Negative Impact on Clinical Outcomes |
| title_short | Moderate Intra-Abdominal Pressure Levels in Robot-Assisted Radical Prostatectomy Seem to Have No Negative Impact on Clinical Outcomes |
| title_sort | moderate intra abdominal pressure levels in robot assisted radical prostatectomy seem to have no negative impact on clinical outcomes |
| topic | robot-assisted radical prostatectomy laparoscopy pneumoperitoneum intraabdominal pressure postoperative inflammation postoperative pain |
| url | https://www.mdpi.com/2077-0383/13/5/1202 |
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