To evaluate the feasibility of performing robotic-assisted laparoscopic prostatectomy (RALP) at an ultralow pressure of 6mmHg and to assess the potential impact on clinical outcomes, as compared to a historical cohort of patients on which RALP was performed at a pressure of 15 mmHg.
We evaluated 600 consecutive RALPs by a single surgeon including 300 at 6mmHg and the previous 300 at 15mmHg. We compared preoperative patient characteristics and outcomes including pain scores, morphine equivalents, length of stay and complications. After implementing the adjustment to 6mmHg, we began allowing for same day discharge in patients meeting established criteria.
All 300 consecutive RALPs were completed at 6mmHg with no pressure adjustments for the entirety of the case. There were no significant differences in patient or pathologic features between groups. BMI was 19.5-44.3kg/m2 in the 6mmHg group. Mean operative time was 10.5 minutes longer and mean estimated blood loss 20mL higher at 6mmHg with no blood transfusions in either group. Mean length of stay was shorter in the 6mmHg group (0.57 v. 1.00 days, p < 0.001) with 43.3% of 6mmHg patients discharged home the day of surgery. There were no differences in morphine equivalents or maximum pain scores in the first 4hrs after surgery, but there was a small improvement in pain scores at 5-12 hours postoperatively (3.2 v. 3.9 (18%), p < 0.001). The 30-day complication rate was 8.7% v. 4.0%, with 30-day hospital readmissions of 5.7% v. 1.0%, for the 15mmHg and 6 mmHg groups, respectively.
RALP at a pneumoperitoneum pressure of 6mmHg was uniformly applicable without increasing complications. There may be a conferred pain benefit to ultralow pneumoperitoneum, which may contribute to safe same-day discharge. This article is protected by copyright. All rights reserved.
BJU international. 2019 Jan 17 [Epub ahead of print]
Matthew C Ferroni, Ronney Abaza
Ohio Health, Robotic Urologic Surgeons, Dublin, OH.