title: Comparison of anesthetic management and outcomes of robot-assisted vs pure laparoscopic radical prostatectomy.
abstract: OBJECTIVE
  Limited data are available regarding the anesthetic management and outcome of patients undergoing pure laparoscopic radical prostatectomy (LRP) and robotic-assisted LRP (RALP). Therefore, our primary objective was to compare the anesthetic management between these 2 groups. Our secondary objective was to determine the incidence of adverse outcomes associated with RALP, which requires an extreme Trendelenburg position.
  
  
  METHODS
  A retrospective observational study.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  A total of 223 men, consisting of 97 LRP patients and 126 RALP patients, treated during a 3-year period (January 2010-December 2012) were retrospectively studied.
  
  
  METHODS
  None.
  
  
  METHODS
  Information on patient demographics, type of anesthesia, anesthetic/pneumoperitoneum/surgical times, intraoperative fluids and blood products, estimated blood loss, intraoperative and postoperative opioid use, postoperative analgesic consumption, length of stay in the postanesthesia care unit, postoperative complications, and hospital stays was collected and compared.
  
  
  RESULTS
  The estimated blood loss was higher in LRP patients than in RALP patients (median, 550 mL vs 200 mL; P < .001). Likewise, 24% of the LRP patients received intraoperative transfusions compared with 0.79% of the RALP patients (P < .001). The RALP patients had a longer anesthesia time (median, 276 vs 259 minutes; P = .032) and a greater intraoperative use of opioids (P < .001). The incidence of complications was similar in both groups with the exception of postoperative nausea and vomiting, which were observed more frequently among the RALP patients than among the LRP patients (33% vs 16%; P = .007).
  
  
  CONCLUSIONS
  This is the first report to compare the anesthetic management of RALP vs LRP. Anesthesiologists can expect RALP surgery to be associated with less blood loss and a need for fewer blood products than traditional LRP surgery. The anesthetic outcome of RALP was generally satisfactory except for a high incidence of postoperative nausea and vomiting.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8602, Japan. Electronic address: komekurahiroshi@gmail.com.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yonekura
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8602, Japan. Electronic address: hirate_hiroyuki@yahoo.co.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hirate
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8602, Japan. Electronic address: kazsobue@med.nagoya-cu.ac.jp.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sobue
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects*; D000777:Anesthetics / Q000008:administration & dosage; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D018475:Head-Down Tilt / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology*; D011468:Prostatectomy / Q000295:instrumentation / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000777:Anesthetics
keywords: Laparoscopy; Postoperative complications; Postoperative nausea and vomiting; Prostatectomy; Robotic surgical procedures