title: Anesthesiologic effects of transperitoneal versus extraperitoneal approach during robot-assisted radical prostatectomy: results of a prospective randomized study.
abstract: OBJECTIVE
  To compare the effects of CO(2) insufflation on hemodynamics and oxygen levels and on acid-base level during Robot-Assisted Radical Prostatectomy (RARP) with transperitoneal (TP) versus extra-peritoneal (EP) accesses.
  
  
  METHODS
  Sixty-two patients were randomly assigned to TP (32) and EP (30) to RARP. Pre-operation data were collected for all patients. Hemodynamic, respiratory and blood acid-base parameters were measured at the moment of induction of anesthesia (T0), after starting CO(2) insufflation (T1), and at 60 (T2) and 120 minutes (T3) after insufflation. In all cases, the abdominal pressure was set at 15 mmHg. Complications were reported according to the Clavien-Dindo classification. Student's two-t-test, with a significance level set at p<0.05, was used to compare categorical values between groups. The Mann-Whitney U-test was used to compare the median values of two nonparametric continuous variables.
  
  
  RESULTS
  The demographic characteristics of the patients in both groups were statistically comparable. Analysis of intra-operative anesthesiologic parameters showed that partial CO(2) pressure during EP was significantly higher than during TP, with a consequent decrease in arterial pH. Other parameters analysed were similar in the two groups. Postoperative complications were comparable between groups. The most important limitations of this study were the small size of the patient groups and the impossibility of maintaining standard abdominal pressure throughout the operational phases, despite attempts to regulate it.
  
  
  CONCLUSIONS
  This prospective randomized study demonstrates that, from the anesthesiologic viewpoint, during RARP the TP approach is preferable to EP, because of lower CO(2) reabsorption and risk of acidosis.
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences Urology, University of Padova, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Dal Moro
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences Urology, University of Padova, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Crestani
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences Urology, University of Padova, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Valotto
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences Urology, University of Padova, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Guttilla
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences Urology, University of Padova, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Soncin
authors.affiliation: Department of Anesthesiology, Azienda Ospedaliera di Padova, Padova, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Mangano
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences Urology, University of Padova, Italy.
authors.forename: Filiberto
authors.initials: F
authors.lastname: Zattoni
mesh_terms: D000368:Aged; D000769:Anesthesia, Inhalation / Q000379:methods*; D000818:Animals; D002245:Carbon Dioxide / Q000378:metabolism*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D061646:Operative Time; D010537:Peritoneum / Q000601:surgery; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D015203:Reproducibility of Results; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000379:methods*; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002245:Carbon Dioxide