title: Safety of Robot-Assisted Radical Prostatectomy with Pneumoperitoneum of 20 mm Hg: A Study of 751 Patients.
abstract: OBJECTIVE
  Early studies describing robot-assisted radical prostatectomy (RARP) reported the use of pneumoperitoneum at a pressure of 15 mm Hg. While higher insufflation pressures (20 mm Hg) may reduce venous oozing and improve visualization, the safety of this method has not been confirmed. This study evaluates the short-term perioperative outcomes of patients undergoing RARP with insufflation pressures of 20 mm Hg.
  
  
  METHODS
  A single-surgeon, prospectively maintained database of patients undergoing RARP was retrospectively analyzed. Patients who underwent RARP with a pneumoperitoneum pressure of 15 and 20 mm Hg for the entire procedure were analyzed. Preoperative and postoperative hemoglobin levels and estimated glomerular filtration rate (eGFR) were compared. Complications, operative time, and estimated blood loss were also examined.
  
  
  RESULTS
  The number of patients in the experimental (20 mm Hg) and control (15 mm Hg) groups were 550 and 201, respectively. The groups were well matched with respect to age and operative time. The experimental group had a significantly smaller decrease in mean hemoglobin levels after surgery (-1.18 vs-2.13 mg/dL, P<0.0001). There was no significant difference in the eGFR on the first day after surgery (postoperative day [POD]1) (88.4 vs 85.0 mL/min/1.73m(2), P=0.11) or in the change in eGFR from preoperative to POD1 levels (-0.49 vs 1.54 mL/min/1.73m(2), P=0.18). The complication rate in the experimental group was 8.55% vs 8.46% in the control group.
  
  
  CONCLUSIONS
  Pneumoperitoneum using a pressure of 20 mm Hg for RARP is safe and has no significant short-term effects on renal function and hemoglobin. Increased insufflation pressure was not associated with a higher complication rate.
authors.affiliation: 1 Division of Urology, Rutgers Robert Wood Johnson Medical School , New Brunswick, New Jersey.
authors.forename: Parth K
authors.initials: PK
authors.lastname: Modi
authors.affiliation: 2 Rutgers Cancer Institute of New Jersey , New Brunswick, New Jersey.
authors.forename: Young Suk
authors.initials: YS
authors.lastname: Kwon
authors.affiliation: 1 Division of Urology, Rutgers Robert Wood Johnson Medical School , New Brunswick, New Jersey.
authors.forename: Neal
authors.initials: N
authors.lastname: Patel
authors.affiliation: 1 Division of Urology, Rutgers Robert Wood Johnson Medical School , New Brunswick, New Jersey.
authors.forename: Michael
authors.initials: M
authors.lastname: Dinizo
authors.affiliation: 1 Division of Urology, Rutgers Robert Wood Johnson Medical School , New Brunswick, New Jersey.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Farber
authors.affiliation: 1 Division of Urology, Rutgers Robert Wood Johnson Medical School , New Brunswick, New Jersey.
authors.forename: Philip T
authors.initials: PT
authors.lastname: Zhao
authors.affiliation: 1 Division of Urology, Rutgers Robert Wood Johnson Medical School , New Brunswick, New Jersey.
authors.forename: Amirali
authors.initials: A
authors.lastname: Salmasi
authors.affiliation: 1 Division of Urology, Rutgers Robert Wood Johnson Medical School , New Brunswick, New Jersey.
authors.forename: Jaspreet
authors.initials: J
authors.lastname: Parihar
authors.affiliation: 3 Department of Anesthesia, Rutgers Robert Wood Johnson Medical School , New Brunswick, New Jersey.
authors.forename: Steven
authors.initials: S
authors.lastname: Ginsberg
authors.affiliation: 2 Rutgers Cancer Institute of New Jersey , New Brunswick, New Jersey.|4 Department of Urology, Kyungpook National University , Daegu, Korea.
authors.forename: Yun-Sok
authors.initials: YS
authors.lastname: Ha
authors.affiliation: 1 Division of Urology, Rutgers Robert Wood Johnson Medical School , New Brunswick, New Jersey.|2 Rutgers Cancer Institute of New Jersey , New Brunswick, New Jersey.
authors.forename: Isaac Y
authors.initials: IY
authors.lastname: Kim
mesh_terms: D000368:Aged; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007327:Insufflation; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D061214:Patient Safety; D011027:Pneumoperitoneum; D011312:Pressure; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins