Anesthetic Management during Robotic-Assisted Minimal Invasive Thymectomy Using the Da Vinci System: A Single Center Experience
Background: Robotic-assisted surgery is gaining more adaption in different surgical specialties. The number of patients undergoing robotic-assisted thymectomy is continuously increasing. Such procedures are accompanied by new challenges for anesthesiologists. We are presenting our primary anesthesio...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-07-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/15/4274 |
| _version_ | 1797413537377681408 |
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| author | Ahmed Mohamed Sharaf-Eldin Shehada Clemens Aigner Till Ploenes Yazan Alnajdawi Lena Van Brakel Arjang Ruhparwar Marcel Hochreiter Marc Moritz Berger Thorsten Brenner Ali Haddad |
| author_facet | Ahmed Mohamed Sharaf-Eldin Shehada Clemens Aigner Till Ploenes Yazan Alnajdawi Lena Van Brakel Arjang Ruhparwar Marcel Hochreiter Marc Moritz Berger Thorsten Brenner Ali Haddad |
| author_sort | Ahmed Mohamed |
| collection | DOAJ |
| description | Background: Robotic-assisted surgery is gaining more adaption in different surgical specialties. The number of patients undergoing robotic-assisted thymectomy is continuously increasing. Such procedures are accompanied by new challenges for anesthesiologists. We are presenting our primary anesthesiologic experience in such patients. Methods: This is a retrospective single center study, evaluating 28 patients who presented with thymoma or myasthenia gravis (MG) and undergone minimal invasive robotic-assisted thoracic thymectomy between 01/2020–01/2022. We present our fast-track anesthesia management as a component of the enhanced recovery program and its primary results. Results: Mean patient’s age was 46.8 ± 18.1 years, and the mean height was 173.1 ± 9.3 cm. Two-thirds of patients were female (n = 18, 64.3%). The preoperative mean forced expiratory volume in the first second (FEV1) was 3.8 ± 0.7 L, forced vital capacity (FVC) was 4.7 ± 1.1 L, and the FEV1/FVC ratio was 80.4 ± 5.3%. After the creation of capnomediastinum, central venous pressure and airway pressure have been significantly increased from the baseline values (16.5 ± 4.9 mmHg versus 13.4 ± 5.1 mmHg, <i>p</i> < 0.001 and 23.4 ± 4.4 cmH<sub>2</sub>O versus 19.3 ± 3.9 cmH<sub>2</sub>O, <i>p</i> < 0.001, respectively). Most patients (n = 21, 75%) developed transient arrhythmias episodes with hypotension. All patients were extubated at the end of surgery and discharged awake to the recovery room. The first 16 (57.1%) patients were admitted to the intensive care unit and the last 12 patients were only observed in intermediate care. Postoperatively, one patient developed atelectasis and was treated with non-invasive ventilation therapy. Pneumonia or reintubation was not observed. Finally, no significant difference was observed between MG and thymoma patients regarding analgesics consumption or incidence of complications. Conclusions: Robotic-assisted surgery is a rapidly growing technology with increased adoption in different specialties. Fast-track anesthesia is an important factor in an enhanced recovery program and the anesthetist should be familiar with challenges in this kind of operation to achieve optimal results. So far, our anesthetic management of patients undergoing robotic-assisted thymectomy reports safe and feasible procedures. |
| first_indexed | 2024-03-09T05:19:28Z |
| format | Article |
| id | doaj.art-aa5cbd4d0e7c453896549f178d9297e8 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T05:19:28Z |
| publishDate | 2022-07-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-aa5cbd4d0e7c453896549f178d9297e82023-12-03T12:42:26ZengMDPI AGJournal of Clinical Medicine2077-03832022-07-011115427410.3390/jcm11154274Anesthetic Management during Robotic-Assisted Minimal Invasive Thymectomy Using the Da Vinci System: A Single Center ExperienceAhmed Mohamed0Sharaf-Eldin Shehada1Clemens Aigner2Till Ploenes3Yazan Alnajdawi4Lena Van Brakel5Arjang Ruhparwar6Marcel Hochreiter7Marc Moritz Berger8Thorsten Brenner9Ali Haddad10Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, GermanyDepartment of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Hospital Essen, University Duisburg-Essen, 45147 Essen, GermanyDepartment of Thoracic Surgery, University Medicine Essen—Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, GermanyDepartment of Thoracic Surgery, University Medicine Essen—Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, GermanyDepartment of Thoracic Surgery, University Medicine Essen—Ruhrlandklinik, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, GermanyDepartment of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Hospital Essen, University Duisburg-Essen, 45147 Essen, GermanyDepartment of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Hospital Essen, University Duisburg-Essen, 45147 Essen, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, GermanyDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, GermanyBackground: Robotic-assisted surgery is gaining more adaption in different surgical specialties. The number of patients undergoing robotic-assisted thymectomy is continuously increasing. Such procedures are accompanied by new challenges for anesthesiologists. We are presenting our primary anesthesiologic experience in such patients. Methods: This is a retrospective single center study, evaluating 28 patients who presented with thymoma or myasthenia gravis (MG) and undergone minimal invasive robotic-assisted thoracic thymectomy between 01/2020–01/2022. We present our fast-track anesthesia management as a component of the enhanced recovery program and its primary results. Results: Mean patient’s age was 46.8 ± 18.1 years, and the mean height was 173.1 ± 9.3 cm. Two-thirds of patients were female (n = 18, 64.3%). The preoperative mean forced expiratory volume in the first second (FEV1) was 3.8 ± 0.7 L, forced vital capacity (FVC) was 4.7 ± 1.1 L, and the FEV1/FVC ratio was 80.4 ± 5.3%. After the creation of capnomediastinum, central venous pressure and airway pressure have been significantly increased from the baseline values (16.5 ± 4.9 mmHg versus 13.4 ± 5.1 mmHg, <i>p</i> < 0.001 and 23.4 ± 4.4 cmH<sub>2</sub>O versus 19.3 ± 3.9 cmH<sub>2</sub>O, <i>p</i> < 0.001, respectively). Most patients (n = 21, 75%) developed transient arrhythmias episodes with hypotension. All patients were extubated at the end of surgery and discharged awake to the recovery room. The first 16 (57.1%) patients were admitted to the intensive care unit and the last 12 patients were only observed in intermediate care. Postoperatively, one patient developed atelectasis and was treated with non-invasive ventilation therapy. Pneumonia or reintubation was not observed. Finally, no significant difference was observed between MG and thymoma patients regarding analgesics consumption or incidence of complications. Conclusions: Robotic-assisted surgery is a rapidly growing technology with increased adoption in different specialties. Fast-track anesthesia is an important factor in an enhanced recovery program and the anesthetist should be familiar with challenges in this kind of operation to achieve optimal results. So far, our anesthetic management of patients undergoing robotic-assisted thymectomy reports safe and feasible procedures.https://www.mdpi.com/2077-0383/11/15/4274thymomamyasthenia gravisthymectomyminimal invasive robotic-assisted surgery |
| spellingShingle | Ahmed Mohamed Sharaf-Eldin Shehada Clemens Aigner Till Ploenes Yazan Alnajdawi Lena Van Brakel Arjang Ruhparwar Marcel Hochreiter Marc Moritz Berger Thorsten Brenner Ali Haddad Anesthetic Management during Robotic-Assisted Minimal Invasive Thymectomy Using the Da Vinci System: A Single Center Experience Journal of Clinical Medicine thymoma myasthenia gravis thymectomy minimal invasive robotic-assisted surgery |
| title | Anesthetic Management during Robotic-Assisted Minimal Invasive Thymectomy Using the Da Vinci System: A Single Center Experience |
| title_full | Anesthetic Management during Robotic-Assisted Minimal Invasive Thymectomy Using the Da Vinci System: A Single Center Experience |
| title_fullStr | Anesthetic Management during Robotic-Assisted Minimal Invasive Thymectomy Using the Da Vinci System: A Single Center Experience |
| title_full_unstemmed | Anesthetic Management during Robotic-Assisted Minimal Invasive Thymectomy Using the Da Vinci System: A Single Center Experience |
| title_short | Anesthetic Management during Robotic-Assisted Minimal Invasive Thymectomy Using the Da Vinci System: A Single Center Experience |
| title_sort | anesthetic management during robotic assisted minimal invasive thymectomy using the da vinci system a single center experience |
| topic | thymoma myasthenia gravis thymectomy minimal invasive robotic-assisted surgery |
| url | https://www.mdpi.com/2077-0383/11/15/4274 |
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