Document Detail

Cardiovascular and respiratory effects of the degree of head-down angle during robot-assisted laparoscopic radical prostatectomy.
MedLine Citation:
PMID:  23348954     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Robot-assisted laparoscopic radical prostatectomy (RALP) requires a steep Trendelenburg position and CO2 pneumoperitoneum for several hours to secure the surgical visual field. The present study was performed to investigate the influence of each angle of Trendelenburg position during RALP on cardiovascular and respiratory homeostasis.
METHODS: Forty-seven ASA physical status 1 and 2 patients underwent open retropubic radical prostatectomy (RRP) or RALP. Patients receiving RALP were randomized to undergo the operation in the 20°, 25° or 30° Trendelenburg position. Heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), end-tidal CO2 pressure (PetCO2 ), tidal volume (Vt), peak inspiratory pressure (PIP) and dynamic compliance (Cdyn) were recorded during the operation.
RESULTS: Angle of head-down tilt was significantly correlated with MAP, PIP and Cdyn, but not with HR, RR or PetCO2 . MAP decreased gradually over time in each group in the Trendelenburg position with pneumoperitoneum. As the angle of head-down tilt became stronger, MAP, RR, PetCO2 and PIP tended to increase and Cdyn tended to decrease.
CONCLUSIONS: This study demonstrated that the degree of the head-down angle at RALP affected the cardiovascular and respiratory parameters. Pneumoperitoneum with head-down position in RALP influenced the cardiovascular and respiratory system to a greater extent than RRP, and these effects were stronger with deeper head-down angle.
Yoshifumi Kadono; Hiroshi Yaegashi; Kazuaki Machioka; Satoru Ueno; Sotaro Miwa; Yuji Maeda; Tohru Miyagi; Atsushi Mizokami; Yuka Fujii; Tsunehisa Tsubokawa; Ken Yamamoto; Mikio Namiki
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2013-01-25
Journal Detail:
Title:  The international journal of medical robotics + computer assisted surgery : MRCAS     Volume:  9     ISSN:  1478-596X     ISO Abbreviation:  Int J Med Robot     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-06     Completed Date:  2013-08-21     Revised Date:  2013-08-26    
Medline Journal Info:
Nlm Unique ID:  101250764     Medline TA:  Int J Med Robot     Country:  England    
Other Details:
Languages:  eng     Pagination:  17-22     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 John Wiley & Sons, Ltd.
Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Japan.
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MeSH Terms
Blood Pressure / physiology
Head-Down Tilt / physiology*
Heart Rate / physiology*
Laparoscopy / methods*
Middle Aged
Patient Positioning / methods*
Prostatectomy / methods*
Respiratory Rate / physiology*
Robotics / methods*
Surgery, Computer-Assisted / methods

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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