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Lung mechanics during video-assisted abdominal surgery in Trendelenburg position: a cross-sectional propensity-matched comparison between classic laparoscopy and robotic-assisted surgery
BACKGROUND: Video-assisted surgery has become an increasingly used surgical technique in patients undergoing major thoracic and abdominal surgery and is associated with significant perioperative respiratory and cardiovascular changes. The aim of this study was to investigate the effect of intraopera...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9677621/ https://www.ncbi.nlm.nih.gov/pubmed/36411445 http://dx.doi.org/10.1186/s12871-022-01900-5 |
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author | Popescu, Mihai Olita, Mihaela Roxana Stefan, Mara Oana Mihaila, Mariana Sima, Romina-Marina Tomescu, Dana |
author_facet | Popescu, Mihai Olita, Mihaela Roxana Stefan, Mara Oana Mihaila, Mariana Sima, Romina-Marina Tomescu, Dana |
author_sort | Popescu, Mihai |
collection | PubMed |
description | BACKGROUND: Video-assisted surgery has become an increasingly used surgical technique in patients undergoing major thoracic and abdominal surgery and is associated with significant perioperative respiratory and cardiovascular changes. The aim of this study was to investigate the effect of intraoperative pneumoperitoneum during video-assisted surgery on respiratory physiology in patients undergoing robotic-assisted surgery compared to patients undergoing classic laparoscopy in Trendelenburg position. METHODS: Twenty-five patients undergoing robotic-assisted surgery (RAS) were compared with twenty patients undergoing classic laparoscopy (LAS). Intraoperative ventilatory parameters (lung compliance and plateau airway pressure) were recorded at five specific timepoints: after induction of anesthesia, after carbon dioxide (CO(2)) insufflation, one-hour, and two-hours into surgery and at the end of surgery. At the same time, arterial and end-tidal CO(2) values were noted and arterial to end-tidal CO(2) gradient was calculated. RESULTS: We observed a statistically significant difference in plateau pressure between RAS and LAS at one-hour (26.2 ± 4.5 cmH(2)O vs. 20.2 ± 3.5 cmH(2)O, p = 0.05) and two-hour intervals (25.2 ± 5.7 cmH(2)O vs. 17.9 ± 3.1 cmH(2)O, p = 0.01) during surgery and at the end of surgery (19.9 ± 5.0 cmH(2)O vs. 17.0 ± 2.7 cmH(2)O, p = 0.02). Significant changes in lung compliance were also observed between groups at one-hour (28.2 ± 8.5 mL/cmH(2)O vs. 40.5 ± 13.9 mL/cmH(2)O, p = 0.01) and two-hour intervals (26.2 ± 7.8 mL/cmH(2)O vs. 54.6 ± 16.9 mL/cmH(2)O, p = 0.01) and at the end of surgery (36.3 ± 9.9 mL/cmH(2)O vs. 58.2 ± 21.3 mL/cmH(2)O, p = 0.01). At the end of surgery, plateau pressures remained higher than preoperative values in both groups, but lung compliance remained significantly lower than preoperative values only in patients undergoing RAS with a mean 24% change compared to 1.7% change in the LAS group (p = 0.01). We also noted a more significant arterial to end-tidal CO(2) gradient in the RAS group compared to LAS group at one-hour (12.9 ± 4.5 mmHg vs. 7.4 ± 4.4 mmHg, p = 0.02) and two-hours interval (15.2 ± 4.5 mmHg vs. 7.7 ± 4.9 mmHg, p = 0.02), as well as at the end of surgery (11.0 ± 6.6 mmHg vs. 7.0 ± 4.6 mmHg, p = 0.03). CONCLUSION: Video-assisted surgery is associated with significant changes in lung mechanics after induction of pneumoperitoneum. The observed changes are more severe and longer-lasting in patients undergoing robotic-assisted surgery compared to classic laparoscopy. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12871-022-01900-5. |
format | Online Article Text |
id | pubmed-9677621 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-96776212022-11-22 Lung mechanics during video-assisted abdominal surgery in Trendelenburg position: a cross-sectional propensity-matched comparison between classic laparoscopy and robotic-assisted surgery Popescu, Mihai Olita, Mihaela Roxana Stefan, Mara Oana Mihaila, Mariana Sima, Romina-Marina Tomescu, Dana BMC Anesthesiol Research BACKGROUND: Video-assisted surgery has become an increasingly used surgical technique in patients undergoing major thoracic and abdominal surgery and is associated with significant perioperative respiratory and cardiovascular changes. The aim of this study was to investigate the effect of intraoperative pneumoperitoneum during video-assisted surgery on respiratory physiology in patients undergoing robotic-assisted surgery compared to patients undergoing classic laparoscopy in Trendelenburg position. METHODS: Twenty-five patients undergoing robotic-assisted surgery (RAS) were compared with twenty patients undergoing classic laparoscopy (LAS). Intraoperative ventilatory parameters (lung compliance and plateau airway pressure) were recorded at five specific timepoints: after induction of anesthesia, after carbon dioxide (CO(2)) insufflation, one-hour, and two-hours into surgery and at the end of surgery. At the same time, arterial and end-tidal CO(2) values were noted and arterial to end-tidal CO(2) gradient was calculated. RESULTS: We observed a statistically significant difference in plateau pressure between RAS and LAS at one-hour (26.2 ± 4.5 cmH(2)O vs. 20.2 ± 3.5 cmH(2)O, p = 0.05) and two-hour intervals (25.2 ± 5.7 cmH(2)O vs. 17.9 ± 3.1 cmH(2)O, p = 0.01) during surgery and at the end of surgery (19.9 ± 5.0 cmH(2)O vs. 17.0 ± 2.7 cmH(2)O, p = 0.02). Significant changes in lung compliance were also observed between groups at one-hour (28.2 ± 8.5 mL/cmH(2)O vs. 40.5 ± 13.9 mL/cmH(2)O, p = 0.01) and two-hour intervals (26.2 ± 7.8 mL/cmH(2)O vs. 54.6 ± 16.9 mL/cmH(2)O, p = 0.01) and at the end of surgery (36.3 ± 9.9 mL/cmH(2)O vs. 58.2 ± 21.3 mL/cmH(2)O, p = 0.01). At the end of surgery, plateau pressures remained higher than preoperative values in both groups, but lung compliance remained significantly lower than preoperative values only in patients undergoing RAS with a mean 24% change compared to 1.7% change in the LAS group (p = 0.01). We also noted a more significant arterial to end-tidal CO(2) gradient in the RAS group compared to LAS group at one-hour (12.9 ± 4.5 mmHg vs. 7.4 ± 4.4 mmHg, p = 0.02) and two-hours interval (15.2 ± 4.5 mmHg vs. 7.7 ± 4.9 mmHg, p = 0.02), as well as at the end of surgery (11.0 ± 6.6 mmHg vs. 7.0 ± 4.6 mmHg, p = 0.03). CONCLUSION: Video-assisted surgery is associated with significant changes in lung mechanics after induction of pneumoperitoneum. The observed changes are more severe and longer-lasting in patients undergoing robotic-assisted surgery compared to classic laparoscopy. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12871-022-01900-5. BioMed Central 2022-11-21 /pmc/articles/PMC9677621/ /pubmed/36411445 http://dx.doi.org/10.1186/s12871-022-01900-5 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Popescu, Mihai Olita, Mihaela Roxana Stefan, Mara Oana Mihaila, Mariana Sima, Romina-Marina Tomescu, Dana Lung mechanics during video-assisted abdominal surgery in Trendelenburg position: a cross-sectional propensity-matched comparison between classic laparoscopy and robotic-assisted surgery |
title | Lung mechanics during video-assisted abdominal surgery in Trendelenburg position: a cross-sectional propensity-matched comparison between classic laparoscopy and robotic-assisted surgery |
title_full | Lung mechanics during video-assisted abdominal surgery in Trendelenburg position: a cross-sectional propensity-matched comparison between classic laparoscopy and robotic-assisted surgery |
title_fullStr | Lung mechanics during video-assisted abdominal surgery in Trendelenburg position: a cross-sectional propensity-matched comparison between classic laparoscopy and robotic-assisted surgery |
title_full_unstemmed | Lung mechanics during video-assisted abdominal surgery in Trendelenburg position: a cross-sectional propensity-matched comparison between classic laparoscopy and robotic-assisted surgery |
title_short | Lung mechanics during video-assisted abdominal surgery in Trendelenburg position: a cross-sectional propensity-matched comparison between classic laparoscopy and robotic-assisted surgery |
title_sort | lung mechanics during video-assisted abdominal surgery in trendelenburg position: a cross-sectional propensity-matched comparison between classic laparoscopy and robotic-assisted surgery |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9677621/ https://www.ncbi.nlm.nih.gov/pubmed/36411445 http://dx.doi.org/10.1186/s12871-022-01900-5 |
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