Experimental study of cardiorespiratory and stress factors in esophageal surgery using robot-assisted thoracoscopic or open thoracic approach.
BACKGROUND
Our aim was to compare cardiovascular and stress response to robotic technology during thoracoscopic mobilization and anastomosis of the esophagus vs the conventional open approach.


METHODS
Randomized experimental study.


METHODS
Department of Experimental Surgery, University of Heidelberg.


METHODS
Twelve pigs randomized to undergo robotic or conventional surgery (6 animals each).


METHODS
Fundus rotation gastroplasty followed by esophageal mobilization and intrathoracic anastomosis by conventional or robotic surgery.


METHODS
Mean arterial pressure, central venous pressure, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, cardiac output, pulmonary vascular resistance, partial oxygen pressure, alveolar-arterial difference in partial pressure of oxygen, and arteriovenous oxygen content difference measured preoperatively, during esophageal manipulation, and 30 minutes after operation. Operative stress was assessed by plasma levels of cortisol and substance P.


RESULTS
Hemodynamic measures showed higher intraoperative central venous pressure and pulmonary vascular resistance in the open surgery group, whereas cardiac output was significantly decreased compared with the robotic group. Blood gas values showed significant deterioration during esophageal manipulation with open surgery in contrast to the robotic group. Substance P and cortisol levels were significantly higher with the open approach.


CONCLUSIONS
The robot-assisted approach is associated with improved intraoperative cardiopulmonary function and seems to be a less stressful technique.
Eisold
Sven
S
Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.
Mehrabi
Arianeb
A
Konstantinidis
Lucas
L
Mieth
Markus
M
Hinz
Ulf
U
Kashfi
Arash
A
Fonouni
Hamidreza
H
Müller-Stich
Beat P
BP
Gebhard
Martha M
MM
Schmidt
Jan
J
Büchler
Markus W
MW
Gutt
Carsten N
CN
D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D001784:Blood Gas Analysis; D016207:Cytokines / Q000097:blood; D004195:Disease Models, Animal; D004797:Enzyme-Linked Immunosorbent Assay; D016629:Esophagectomy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D016343:Monitoring, Intraoperative / Q000379:methods; D018384:Oxidative Stress; D011336:Probability; D011652:Pulmonary Circulation / Q000502:physiology; D011659:Pulmonary Gas Exchange; D011897:Random Allocation; D012371:Robotics; D012680:Sensitivity and Specificity; D013373:Substance P / Q000097:blood; D013552:Swine; D020775:Thoracic Surgery, Video-Assisted / Q000295:instrumentation / Q000379:methods*; D013908:Thoracotomy / Q000379:methods*
D016207:Cytokines; D013373:Substance P