Robotic-assisted laparoscopic prostatectomy (RALP) is the gold standard surgical technique in prostate surgery. Many Robotic-laparoscopic surgical techniques also require the intraoperative deep Trendelenburg position and intravenous fluid restriction during surgery. However, the possible side effects of the deep Trendelenburg's position and the fluid restriction on the cardiovascular and renal systems during surgery are unknown. Although the Trendelenburg position is a life-saving maneuver in hypovolemic patients, it also carries undesirable risks. Long console time may contribute to the development of acute kidney injury (AKI) by prolonging the Trendelenburg time and the fluid-restricted time. In this study, investigators aimed to demonstrate the effect of console time on the development of AKI. Investigators also aimed to determine the hemodynamic risk factors that cause the development of AKI in patients monitored with the pressure Recording Analytical Method (PRAM).
Although open surgery has been used for a long time in the treatment of prostate diseases, robotic-assisted laparoscopic prostatectomy (RALP) has become more common in the last 20 years. The excellence in results has made the use of the robot the gold standard in prostate surgery. However, the presence of two critical factors during RALP surgery still bothers clinicians. The first of these is severe fluid restriction and the other is the deep Trendelenburg position and pneumoperitoneum. The prolongation of the robotic console time also causes the prolongation of fluid restriction and Trendelenburg time. This combination may cause significant pathophysiological changes in both the renal and cardiac systems and may lead to postoperative acute renal injury (AKI). AKI is a serious clinical complication with increasing incidence and is associated with adverse short-term and long-term outcomes worldwide, resulting in a large healthcare burden. Intraoperative advanced monitoring techniques can contribute to the prevention of renal damage that may occur by providing early recognition of these pathophysiological changes occurring in the renal and cardiac systems. The aim of our study was to determine the effect of console duration on the incidence of AKI after RALP which was managed using intraoperative advanced monitoring techniques (pressure recording analytical method-PRAM). In addition, this study aimed to evaluate the ability of changes in hemodynamic parameters to predict the development of AKI in RALP patients who underwent restrictive fluid therapy.
Study Type
OBSERVATIONAL
Enrollment
42
0,5 ml/hour fluid administration during prostatic anastomosis. After general anesthesia induction, the patients were placed in the deep Trendelenburg position (at least 25°-45° upside down).
Acibadem Altunizade Hospital
Istanbul, Turkey (Türkiye)
Console time was measured for evaluating the effect of restrictive fluid therapy and prostatic urethra anastomosis time on the development of acute kidney injury.
Console time ( minute) indicates the restrictive fluid therapy time, prostatic resection, and prostatic urethra anastomosis time.
Time frame: The duration of the measurement was defined as during the surgery.
Stroke volume variation (SVV) was measured for evaluation of volume status
Stroke volume variation (SVV,%), was monitored using the pressure recording analytic method. SVV is a parameter used to asses cardiac preload and fluid responsiveness.
Time frame: The duration of the measurement was defined from one minute before induction to the end of the surgery
Pulse pressure variation (PPV) was measured for evaluation of volume status
Pulse pressure variation (PPV,%) was monitored using the pressure recording analytic method. PPV is a parameter used to asses cardiac preload and fluid responsiveness
Time frame: The duration of the measurement was defined from one minute before induction to the end of the surgery
Cardiac power output (CPO) was measured for evaluation of cardiac power reserve
Cardiac power output (CPO, Watt) was monitored using the pressure recording analytic method. CPO is a parameter used to asses cardiac reserve
Time frame: The duration of the measurement was defined from one minute before induction to the end of the surgery
Cardiac index (CI) was measured for evaluating cardiac flow
Cardiac index (CI, L/min/m2), was monitored using the pressure recording analytic method. CI is a parameter used to asses cardiac stroke volume.
Time frame: The duration of the measurement was defined from one minute before induction to the end of the surgery
Dp/Dt was measured to assess cardiac systolic function
Dp/Dt(mmHg/msn), was monitored using the pressure recording analytic method. Dp/Dt is a parameter used to asses cardiac contractility.
Time frame: The duration of the measurement was defined from one minute before induction to the end of the surgery
Systolic arterial pressure (SAP) was measured for evaluating perfusion pressure
Systolic arterial pressure (SAP- mm/Hg) was monitored using the pressure recording analytic method. SAP is a parameter used to assess the pressure of the arterial system during cardiac systole
Time frame: The duration of the measurement was defined from one minute before induction to the end of the surgery
Diastolic arterial pressure (DAP) was measured for evaluating perfusion pressure
Diastolic arterial pressure (DAP, mm/Hg) was monitored using the pressure recording analytic method. DAP is a parameter used to assess the pressure of the arterial system during cardiac diastole
Time frame: The duration of the measurement was defined from one minute before induction to the end of the surgery
Mean arterial pressure (MAP) was measured for evaluating perfusion pressure
Mean arterial pressure (MAP, mm/Hg) was monitored using the pressure recording analytic method. MAP is a parameter used to assess organ perfusion
Time frame: The duration of the measurement was defined from one minute before induction to the end of the surgery
Heart rate (HR) was measured for evaluating heart ritm
Heart rate( HR, bpm) was monitored using the pressure recording analytic method. HR is a parameter used to assess the cardiac rate
Time frame: The duration of the measurement was defined from one minute before induction to the end of the surgery
Arterial elastance ( Ea) was measured for evaluation of cardiac afterload and arterial ton
Ea ((mmHg m-2ml-1) was monitored using the pressure recording analytic method. Ea is a parameter used to assess cardiac afterload and arterial tone
Time frame: The duration of the measurement was defined from one minute before induction to the end of the surgery
The Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used for the definition and staging of acute kidney injury .
KDIGO criteria ( stage) classify acute kidney injury based on changes in serum creatinine levels and urine output.
Time frame: The duration of the measurement was defined from the end of the surgery to the 3 days after surgery
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