Randomized Trial of Ultralow vs Standard Pneumoperitoneum during Robotic Prostatectomy

No AccessJournal of UrologyAdult Urology1 Sep 2022Randomized Trial of Ultralow vs Standard Pneumoperitoneum during Robotic Prostatectomy Ronney Abaza and Matthew C. Ferroni Ronney AbazaRonney Abaza *Correspondence: Central Ohio Urology Group, 5040 Bradenton Ave., Dublin, Ohio 43017 telephone: 614-796-2842; FAX: 614-729-7702; E-mail Address: [email protected] Central Ohio Urology Group, Columbus, Ohio Mount Carmel St. Ann's Hospital Prostate Cancer Program, Columbus, Ohio More articles by this author and Matthew C. FerroniMatthew C. Ferroni Mercy Medical Center, Cedar Rapids, Iowa More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002729AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Laparoscopic and robotic surgery have traditionally been performed with pneumoperitoneum of 12–15 mmHg. Based upon our previous retrospective study showing an advantage to using ultralow pneumoperitoneum during robotic prostatectomy (RP), we performed a randomized, double-blinded, controlled trial of RP at 6 mmHg vs 15 mmHg to assess postoperative pain and opioid use. Materials and Methods: Patients undergoing RP with lymphadenectomy by a single surgeon were randomized to pneumoperitoneum pressures of 6 mmHg vs 15 mmHg. Pain scores and opioid use were recorded every 2 hours until discharge. Groups underwent intention-to-treat analysis on the primary outcome of pain scores up to 8 hours after post-anesthesia care unit. Results: A total of 138 patients were randomized to RP at 6 mmHg or 15 mmHg (67 and 71, respectively). Mean console time was 7 minutes longer at 6 mmHg (135 vs 128 minutes, p=0.02). Mean estimated blood loss was similar (p=0.4) with no transfusions in either group. Most patients were discharged on the same day as surgery (88% vs 84%, p=0.5). There was no statistically significant difference observed in morphine equivalents administered during surgery or used postoperatively, yet 6 mmHg patients had lower immediate (0–4 hours) mean pain scores (2.1 vs 3.5, p <0.01) and lower maximum pain scores (3.0 vs 5.2, p <0.01). Shoulder pain was lower in 6 mmHg patients (0.03 vs 0.15, p=0.01), as was groin pain (0.6 vs 1.2 p=0.01). Patients reported flatus earlier with 6 mmHg (mean 1.0 day vs 1.3 days, p <0.01). Conclusions: Pneumoperitoneum pressure of 6 mmHg during RP has several advantages over the commonly used level of 15 mmHg without any identified disadvantages. Surgeons should consider using lower insufflation pressures. References 1. : Laparoscopic radical prostatectomy with a remote controlled robot. J Urol 2001; 165: 1964. Link, Google Scholar 2. : Abdominal distention alters regional pleural pressures and chest wall mechanics in pigs in vivo. J Appl Physiol 1991; 70: 2611. 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Support: This study was funded by an unrestricted grant from ConMed, Inc. Conflict of Interest: Ronney Abaza: Intuitive Surgical and VTI. Ethics Statement: Study received Institutional Review Board approval (IRB No. OH1-13-06218). ClinicalTrials.gov identifier: NCT03630393. Editor's Note: This article is the second of 5 published in this issue for which Category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 746 and 747. © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 208Issue 3September 2022Page: 626-632 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.Keywordsprostatectomyprostatic neoplasmspneumoperitoneuminsufflationrobotic surgical proceduresAcknowledgmentsThe authors acknowledge the OhioHealth Research Institute for assistance with this study and Lynn Shaffer, PhD for assistance with statistics.MetricsAuthor Information Ronney Abaza Central Ohio Urology Group, Columbus, Ohio Mount Carmel St. Ann's Hospital Prostate Cancer Program, Columbus, Ohio *Correspondence: Central Ohio Urology Group, 5040 Bradenton Ave., Dublin, Ohio 43017 telephone: 614-796-2842; FAX: 614-729-7702; E-mail Address: [email protected] More articles by this author Matthew C. Ferroni Mercy Medical Center, Cedar Rapids, Iowa More articles by this author Expand All Submitted August 25, 2021; accepted April 16, 2022; published May 2, 2022. Support: This study was funded by an unrestricted grant from ConMed, Inc. Conflict of Interest: Ronney Abaza: Intuitive Surgical and VTI. Ethics Statement: Study received Institutional Review Board approval (IRB No. OH1-13-06218). ClinicalTrials.gov identifier: NCT03630393. Editor's Note: This article is the second of 5 published in this issue for which Category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 746 and 747. Advertisement PDF downloadLoading ...