Prostatectomía robótica: análisis anestesiológico de cirugías urológicas robóticas, un estudio prospectivo

ResumenJustificación y objetivosAunque muchas características de la prostatectomía robótica sean similares a las de las laparoscopias urológicas convencionales (como la prostatectomía laparoscópica), el procedimiento está asociado con algunos inconvenientes, incluyendo el acceso intravenoso limitado, tiempo quirúrgico relativamente largo, posición de Trendelenburg profunda y presión intraabdominal alta. El objetivo principal fue describir las alteraciones respiratorias y hemodinámicas y las complicaciones relacionadas con la presión intraabdominal elevada y con la posición de Trendelenburg profunda en pacientes sometidos a prostatectomía robótica. El objetivo secundario fue revelar criterios seguros de alta del quirófano.MétodosCincuenta y tres pacientes sometidos a prostatectomía robótica entre diciembre de 2009 y enero de 2011 fueron incluidos en un estudio prospectivo. Las principales medidas de resultado fueron: monitorización no invasiva, monitorización invasiva y gasometría realizada en decúbito dorsal (T0), Trendelenburg (T1), Trendelenburg+neumoperitoneo (T2), Trendelenburg predesinsuflación (T3), Trendelenburg posdesinsuflación (T4) y posiciones supinas (T5).ResultadosCincuenta y tres pacientes sometidos a prostatectomía robótica fueron incluidos en el estudio. El principal reto clínico en nuestro grupo de estudio fue la elección de la estrategia de ventilación para controlar la acidosis respiratoria, que es detectada por medio de la presión de dióxido de carbono espirado y la gasometría. Además, la presión arterial media permaneció inalterada, y la frecuencia cardíaca disminuyó significativamente y fue necesario intervenir. Los valores de la presión venosa central también estaban por encima de los límites normales.ConclusiónLa acidosis respiratoria y los síntomas clínicos «similares a la obstrucción de las vías aéreas» fueron los principales desafíos asociados con los procedimientos de prostatectomía robótica.AbstractBackground and objectivesAlthough many features of robotic prostatectomy are similar to those of conventional laparoscopic urological procedures (such as laparoscopic prostatectomy), the procedure is associated with some drawbacks, which include limited intravenous access, relatively long operating time, deep Trendelenburg position, and high intra-abdominal pressure. The primary aim was to describe respiratory and hemodynamic challenges and the complications related to high intra-abdominal pressure and the deep Trendelenburg position in robotic prostatectomy patients. The secondary aim was to reveal safe discharge criteria from the operating room.MethodsFifty-three patients who underwent robotic prostatectomy between December 2009 and January 2011 were prospectively enrolled. Main outcome measures were non-invasive monitoring, invasive monitoring and blood gas analysis performed at supine (T0), Trendelenburg (T1), Trendelenburg + pneumoperitoneum (T2), Trendelenburg-before desufflation (T3), Trendelenburg (after desufflation) (T4), and supine (T5) positions.ResultsFifty-three robotic prostatectomy patients were included in the study. The main clinical challenge in our study group was the choice of ventilation strategy to manage respiratory acidosis, which is detected through end-tidal carbon dioxide pressure and blood gas analysis. Furthermore, the mean arterial pressure remained unchanged, the heart rate decreased significantly and required intervention. The central venous pressure values were also above the normal limits.ConclusionRespiratory acidosis and “upper airway obstruction-like” clinical symptoms were the main challenges associated with robotic prostatectomy procedures during this study

Ureteric Duplication is not a Contraindication for Robot-Assisted Laparoscopic Radical Cystoprostatectomy and Intracorporeal Studer Pouch Formation

The authors found that duplicated ureters was not a contraindication to robot-assisted laparoscopic radical cystoprostatectomy in this case

What if the Hand Piece Spring Disassembles During Robotic Radical Prostatectomy?

These authors report on the successful management of a disassembled hand piece spring during robotic radical prostatectomy

Üreter taşı hastalarında postüreteroskopik lezyon skalası ile emilen irrigasyon sıvısı arasında bağlantı var mı?

Objective: Post-Ureteroscopic Lesion Scale (PULS) is used to classify ureteral wall injury that occurs during ureteroscopy. In this study we presented the preliminary results of absorbed irrigation fluid volumes according to PULS grades. Material and Methods: Forty-four patients to whom 7F semirigid ureteoscopy was performed due to ureteral stone were included in the study. All patients received general anesthesia. Izotonic containing 1% ethanol was used as irrigation fluid. Ethanol concentration in venous blood was commenced to be measured at the start of irrigation use and was carried on at 15-minute intervals including the post-operative period in the recovery room. Absorbed fluid volume was calculated by using blood ethanol concentrations. Irrigation time, stone size and PULS grade were recorded. Results: Mean operation time was found to be 44.2 ± 19.9 minutes. Mean stone size was measured to be 12.7± 6 mm and mean irrigation fluid amount used was 1371±1262 ml. PULS grade of 0 was seen in 26 patients and that of 1 or more was seen in 18 patients. No patient had a PULS grade of 3 or 4. Mean absorbed fluid volume was measured to be 58 ± 50,6 ml. No significant correlation was found between PULS grade and mean absorbed fluid volume. Conclusion: Fluid absorption during URS is not correlated with the PULS grade. Semirigid URS is a safe treatment option for ureteral stone disease in terms of the level of irrigation fluid being absorbed.Amaç: Üreteroskopi esnasında üreter duvarında oluşan hasarı sınıflandırmak için Post-Üreteroskopik Lezyon Skalası (PULS) kullanılmaktadır. Bu çalışmada PULS derecelerine göre absorbe edilen irrigasyon sıvı hacimlerinin ön sonuçlarını sunduk. Gereç ve Yöntemler: Bu çalışmaya üreter taşı nedeniyle 7 F semirijid üreteroskopi uygulanan 44 hasta dahil edildi. Tüm hastalara genel anestezi uygulandı. %1 etanol içeren izotonik irrigasyon sıvısı olarak kullanıldı. Venöz kan etanol konsantrasyonları irrigasyon kullanılmaya başlaması ile ölçülmeye başlandı, operasyon sonrası derlenme odasını kapsayacak şekilde 15 dakika arayla periyodik ölçüldü. Absorbe edilen sıvı hacmi kan etanol konsantrasyonları kullanılarak hesaplandı. İrrigasyon süresi, taş boyutu, PULS derecesi kaydedildi.Bulgular: Ortalama operasyon süresi 44.2 ± 19.9 dakika olarak saptandı. Ortalama taş hacmi 12.7± 6 mm ve ortalama kullanılan irrigasyon sıvı miktarı 1371±1262 mL olarak ölçüldü. Hastaların 26’sınde PULS derecesi 0 iken 18’inde 1 veya üzerindeydi üzerindeydi. Hiçbir hastada PULS derecesi 3 veya 4 olmadı. Ortalama absorbe edilen sıvı hacmi 58 ± 50,6 mL olarak hesaplandı. PULS derecesi ile ortalama absorbe edilen sıvı miktarı arasında istatistiksel anlamlı fark saptanmadı.Sonuç: URS esnasında oluşan PULS derecesi 1-2 olan veya düşük dereceli submukozal üreter lezyonlarıyla sıvı emilimi korele bulunmamıştır. Semirijid URS, üreter taşı hastalığı tedavisinde irrigasyon sıvısının emilimi açısından güvenli bir yöntemdir

Is Positron Emission Tomography Reliable to PredictPost-Chemotherapy Retroperitoneal Lymph NodeInvolvement in Advanced Germ Cell Tumors of theTestis?

PURPOSE: To evaluate if 18 fluorodeoxyglucose positron emission tomography(18FDG-PET) scan could identify post-chemotherapy retroperitoneal lymphnode (RPLN) involvement in advanced germ cell tumors of the testis.MATERIALS AND METHODS: Between January 2005 and January 2009, 16patients with advanced germ cell tumors of the testis underwent RPLNdissection (RPLND) following chemotherapy. Before RPLND, abdominalcomputed tomography (CT), magnetic resonance imaging (MRI), and18FDG-PET were performed in all the patients. Findings on 18FDG-PETwere compared with pathological evaluation of the removed lymphatic tissue.RESULTS: Both abdominal CT and MRI demonstrated retroperitonealmasses in all the patients following chemotherapy. Although PET did not demonstrate any activity in 8 patients, tumor was detected histopathologically.In 1 patient, 18FDG-PET demonstrated activity; however, no tumor wasdetected on pathology. Of the remaining 7 patients, 18FDG-PET findingswere concordant with the histopathological findings. No activity wasdetected in 2 patients with no tumors whereas all 5 patients harboring viabletumor cells showed positive 18FDG-PET activity. In our study, sensitivityand specificity of 18FDG-PET in detecting RPLN involvement were detectedto be 39% and 67%, respectively.CONCLUSION: 18FDG-PET imaging does not seem to be a reliable methodin detecting RPLN involvement in advanced germ cell tumors of the testisfollowing chemotherapy. Therefore, we neither recommend routine use of18FDG-PET scanning nor decide the treatment work-up by solely relying onthe 18FDG-PET findings in this patient group

[Ahmet Ziya Akbulut'a ait görsel çalışmalar]

Taha Toros Arşivi, Dosya No: 16-Ahmet Ziya-Mahmut Akbulu