Impact of insufflator/aspirator versus exclusive insufflator during robotic radical prostatectomy: a comparative prospective cohort study
Journal
Annals of Medicine & Surgery
ISSN
2049-0801
Date Issued
2023
Author(s)
Juan Cristóbal Bravo
Rodrigo Pinochet
Marcelo Orvieto
Type
journal-article
URL Institutional Repository
Abstract
<jats:sec>
<jats:title>Background:</jats:title>
<jats:p>New generation devices that combine high-flow insufflation with smoke aspiration using continuous gas recirculation ]so-called Insufflator/aspirator systems (IAS)] have recently been developed to generate pneumoperitoneum. The use of an IAS could have an impact on surgical compared to conventional insufflation systems (CIS). The present study aimed to compare the clinical effectiveness/safety, healthorganizational, and pathological/oncological outcomes of the CIS versus IAS during robot-assisted radical prostatectomy (RARP).</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods:</jats:title>
<jats:p>Comparative retrospective cohort study including patients with non-metastatic prostate cancer treated with RARP by four expert surgeons at a robotic referral centre between January 2020 and December 2021. A CIS was used until 15 March 2021, and the IAS thereafter. Data were extracted from the Institutional Review Board-approved (#1064) retro and prospective institutional database.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results:</jats:title>
<jats:p>The final analysis included 299 patients (143 CIS; 156 IAS). We found no statistically significant differences in demographic data and preoperative results, allowing adequate group comparison. The rate of complications of any degree (9.1% and 1.9%, <jats:italic toggle="yes">P</jats:italic><0.05) and major complications (4.2% and 0.6%, <jats:italic toggle="yes">P</jats:italic><0.05) were lower in the IAS group. Accordingly, the hospital stay was shorter in the IAS group (<jats:italic toggle="yes">P</jats:italic><0.05); however, the small size of this statistically significant difference probably lacks clinical value (1.9±1.6 vs. 1.6±0.8 days). There was no significant difference in surgical time, bleeding, pathological findings, or oncological results.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions:</jats:title>
<jats:p>Data from this large group of patients showed that the rate of overall complications, the rate of major complications, and the length of stay were lower in the IAS group. Implementing the IAS in RARP patients increased the occurrence of SCE and affected our daily practice of transversus abdominis plane block. Interpretation of the results should be made with caution since the design of this study did not allow for the identification of a causal relationship.</jats:p>
</jats:sec>
<jats:title>Background:</jats:title>
<jats:p>New generation devices that combine high-flow insufflation with smoke aspiration using continuous gas recirculation ]so-called Insufflator/aspirator systems (IAS)] have recently been developed to generate pneumoperitoneum. The use of an IAS could have an impact on surgical compared to conventional insufflation systems (CIS). The present study aimed to compare the clinical effectiveness/safety, healthorganizational, and pathological/oncological outcomes of the CIS versus IAS during robot-assisted radical prostatectomy (RARP).</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods:</jats:title>
<jats:p>Comparative retrospective cohort study including patients with non-metastatic prostate cancer treated with RARP by four expert surgeons at a robotic referral centre between January 2020 and December 2021. A CIS was used until 15 March 2021, and the IAS thereafter. Data were extracted from the Institutional Review Board-approved (#1064) retro and prospective institutional database.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results:</jats:title>
<jats:p>The final analysis included 299 patients (143 CIS; 156 IAS). We found no statistically significant differences in demographic data and preoperative results, allowing adequate group comparison. The rate of complications of any degree (9.1% and 1.9%, <jats:italic toggle="yes">P</jats:italic><0.05) and major complications (4.2% and 0.6%, <jats:italic toggle="yes">P</jats:italic><0.05) were lower in the IAS group. Accordingly, the hospital stay was shorter in the IAS group (<jats:italic toggle="yes">P</jats:italic><0.05); however, the small size of this statistically significant difference probably lacks clinical value (1.9±1.6 vs. 1.6±0.8 days). There was no significant difference in surgical time, bleeding, pathological findings, or oncological results.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions:</jats:title>
<jats:p>Data from this large group of patients showed that the rate of overall complications, the rate of major complications, and the length of stay were lower in the IAS group. Implementing the IAS in RARP patients increased the occurrence of SCE and affected our daily practice of transversus abdominis plane block. Interpretation of the results should be made with caution since the design of this study did not allow for the identification of a causal relationship.</jats:p>
</jats:sec>
Subjects
artificial pneumoperitoneum
;
prostate cancer
;
prostatectomy
;
robotic-assisted surgery
;
technology assessment
;
dexmedetomidine
;
prostate specific antigen
;
abdominal drainage
;
acute kidney failure
;
adult
;
aged
;
article
;
bleeding
;
blood transfusion
;
body mass
;
cardioversion
;
cohort analysis
;
conventional insufflation system
;
data extraction
;
deep vein thrombosis
;
demographics
;
drug safety
;
enhanced recovery after surgery
;
hematoma
;
hemostasis
;
hospital readmission
;
hospitalization
;
human
;
intensive care unit
;
laparoscopy
;
length of stay
;
major clinical study
;
male
;
medical procedures
;
metastatic prostate cancer
;
nuclear magnetic resonance imaging
;
outcome assessment
;
pelvis lymphadenectomy
;
pneumoperitoneum
;
prostate cancer
;
prostatectomy
;
retrospective study
;
robot-assisted prostatectomy
;
supraventricular tachycardia
;
tachycardia