OUR INITIAL EXPERIENCE WITH LAPAROSCOPIC RADICAL CYSTECTOMY

Background and objectives: In this era of minimally invasive surgeries, at the University Clinic for Urologic Surgery in Skopje, the laparoscopic radical cystectomy (LRS) was performed in 11 patients for the first time. In this paper, we have evaluated and summarized the anesthesia management, features and complications of LRC. Material and method: In a retrospective manner, we evaluated all patents who underwent LRC at our Clinic over a one-year period. We noted and analyzed the following parameters: patients’ demographic data, preoperatively and postoperatively, laboratory data, intraoperative fluid volume, estimated blood loss, allogeneic transfusion requirements. Respiratory parameters including arterial blood gas data, anesthesia time, surgical time, time of oral intake, admission to ICU, hospital stay and any adverse events during the whole period of hospitalization were also analyzed. Results: This evaluation included 11 patients who were successfully operated and their data were analyzed. Patients had similar demographic characteristics. Estimated intraoperative blood loss was 472 ml and decreased transfusion requirement was noticed. Due to prolonged surgical time and CO2 pneumoperitoneum, hypercarbia was observed in few patients. Patients had shorter period of bowel dysfunction and rapid oral intake, shorter hospital stay and fewer complications. Conclusion: We believe that these data from our initial experience with newly performed minimally invasive radical cystectomy will reflect to our daily routine practice in radical cystectomy surgery towards laparoscopy. However, some larger prospective evaluation is to be made for summarizing the overall conclusions. Key words: anesthesia consideration, laparoscopy, radical cystectom

Arterial blood gas alterations in retroperitoneal and transperitoneal laparoscopy

Background: Due to its numerous benefits laparoscopic surgery become very popular among physicians, hospitals and patients nowadays. In the urologic pathology laparoscopy can be performed with retroperitoneal or transperitoneal approach. Insufflation of CO2 for achieving visibility in both of the approaches can be absorbed in the vessels and can lead to alterations in arterial blood gasses. Material and Method: Study population was elective urologic patients scheduled for laparoscopic surgery. Investigated arterial blood gas variables were determined in three time points: T0 before induction – basal, T1 after one hour of CO2 insufflation, and T2 at the end of the surgery. Results: Alterations in arterial blood gasses were seen in T1 and T2 for PaO2 in retroperitoneal vs transperitoneal group 173.3 ± 19 vs 196.6 ± 29 (p < 0.003) and 95.5 ± 5.4 vs 101.1 ± 8.2 (p < 0.001). The PaCO2 was also statistically significant in second observed time point T1 in retroperitoneal vs transperitoneal group 45.9 ± 4.1 vs 38.2 ± 0.3 (p < 0.002). Conclusion: The findings that we have presented can suggest that both approaches are safe although hypercarbia is observed in retroperitoneal group. Key Words: arterial blood gasses, retroperitoneal laparoscopy, transperitoneal laparoscopy, urologic laparoscopy. Corresponding author: Aleksandra Gavrilovska-Brzanov, University Clinic for Anesthesia, Reanimation and Intensive Care, Skopje, Republic of North Macedoni

Perioperative outcomes of laparoscopic and open retropubic radical prostatectomy

Introduction/Objective. Radical prostatectomy (RP) is a treatment option with high curative potential in patients with prostate cancer of moderate-risk. The aim of the study is to assess perioperative results of laparoscopic RP (LRP) and open retropubic RP (ORRP). Methods. From 2016 to 2020, a total of 244 patients undergone RP, as follow: 145 patients LRP and 99 patients ORRP. Demographic data, preoperative parameters, perioperative and pathological outcomes were analyzed and compared among LRP and ORRP groups. Results. In regard to demographic data and preoperative parameters (BMI, mean age, median pretreatment prostate-specific antigen, clinical stage and Gleason score from biopsy), there are no differences between the observed groups. Patients from ORRP group had significantly shorter operative time (p < 0.05). Patients from LRP group had major advantages in regard to estimated blood loss (EBL) (550 ml for LRP vs. 1450 ml for ORRP), hospitalization time (six days for LRP vs. nine days for ORRP), catheter removal (6.5 days for LRP vs. 12 days for ORRP), overall complication rates (29% for LRP vs. 48.4% for ORRP) and blood transfusion rates (22.7% for LRP and 37.4% for ORRP). Conclusion. Both LRP and ORRP provide favorable operative results in terms of efficacy, safety and oncologic outcome. However, patients undergoing LRP were more likely to have less EBL, shorter length of hospital stay, earlier catheter removal and lower rates of overall perioperative complications

Evaluation of changes in serum concentration of sodium in a transurethral resection of the prostate

Introduction and objectives: The purpose of this study was to evaluate changes in serum electrolytes during Transurethral resection of the prostate (TURP) and to evaluate the degree of correlation of hyponatremia and the factors that affect the incidence of TURP syndrome and to show the impact of the duration of the procedure on the severity of hyponatremia due to absorption of irrigation fluid in the systemic circulation. Materials and Methods: This study examined 60 male patients planned for elective TURP. The level of serum electrolytes are determined by taking venous blood samples preoperatively and Postope-ratively and when the duration of the operation was longer than 60 minutes, the level of serum electrolytes was determined intraoperative. The amount of used irrigation fluid, the weight of resec-tion prostate, and duration of surgery, were also followed. Patients were divided in two groups according to the length of the surgical procedure: Group 1 (30–60 min) and Group 2 (> 60 min). Results: Statistically significant reduction of serum sodium and the elevation of the potassium level in serum observed postoperatively and was directly proportional to the volume of of the used irrigation fluid, the duration of the procedure and volume of the resected prostate. Conclusions: To evaluate changes in serum electrolyte during TURP is simple and economical method for the indirect estimation of irrigation fluid absorption into the systemic circulation during TURP and opportunity for early identification of TURP syndrome. Key words: TURP, TURP syndrome, hiponatremia, hiperkalemia

EFFECT OF ADDING DEXAMETHASONE AS A ROPIVACAINE ADJUVANT IN ULTRASOUND-GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK FOR INGUINAL HERNIA REPAIR

Abstract Background: The transverses abdominals plane block (TAP) is a regional anesthesia technique that provided analgesia to the parietal peritoneum, skin and muscles of the anterior abdominal wall. The aim of this randomized double-blind study was to evaluate postoperative analgesia on patients undergoing open inguinal hernia repair under general anesthesia (GA), (GA + TAP) block preformed with ropivacaine and (GA + TAP-D) block preformed with ropivacaine and 4 mg dexamethasone. Methods: 90 (ASA I-II) adult patients for unilateral open inguinal hernia repair were included in this study. In group I (n = 30) patents received only general anesthesia (GA). Patients in group II (n = 30) received GA and unilateral TAP block with 25 ml of 0.5% ropivacaine and the patients in group III (n = 30) received GA and unilateral TAP-D block with 25 ml of 0.5% ropivacaine + 4 mg Dexamethadsone. In this study we assessed the pain score -VAS at rest at 2, 4, 6, 12 and 24 hours after the operation and the total analgesic consumption of morphine over 24 hours. Results: There were statistically significant differences in the VAS scores between group I, group II and group III at all postoperative time points -2 hr , 4 hr , 6 hr , 12 hr and 24 hr. (p &lt; 0.00001). The cumulative 24 hours morphine consumption after the operation was significantly lower in group III (5.53 1.21 mg) than in group II (6.16 2.41 mg) and group I (9.26 2.41 mg). This difference is statistically significant (p &lt; 0.00001). Conclusion: Concerning the inguinal hernia repair we found better postoperative pain scores and 24 hours reduction of the morphine consumption in group III (GA and TAP-D block) compared with group I (GA) and group II (GA + TAP block)