Duygu KARA, Cafer Mutlu SARİKAS, Fevzi BEDİR

Robot-assisted surgical cases: A single center experience

The objective of this study is to present our experience with robotic surgeries in general surgery, urology, gynecology, and ear-nose-throat (ENT) departments.Robotic surgery performed in cases from the Erzurum Regional Training and Research Hospital from February 2015 to July 2018 were retrospectively included in the study. Patient data, including age, gender, ASA score, underlying disease, smoking habits, type of surgery, invasive procedures (arterial cannulation, or central venous catheter), laparotomy requirement, anesthesia, surgery, discharge times, amount of bleeding, and intra- and post-operative complications were recorded from the digital database system and anesthesia hospital records during monitoring. A total of two hundred twenty-one patients were included. Of these 112 (50.6%) from urology, 53 (23.9%) from general surgery, 46 (20.8%) from gynecology, and 10 (4.5%) from ENT departments. The median age of the patients was 61 (17-91) years, and the male/female ratio was 1.9 (145/76). Most patients (63.3%) had ASA-II scores. Ten patients (4.7%) needed conversion to laparotomy. Mean duration of anesthesia and surgery was longest in general surgery procedures. Urology department patients had the longest time to discharge. The Trendelenburg position was used only during urology and gynecology operations. Hypotension was the most frequent intraoperative complication, and nausea was the most common postoperative complication. In general, both intra- and post-operative complications were mostly seen in the urology department. No intra- or post-operative complications were observed in ENT operations. Robotic surgeries are continuing to develop and evolve and be used in several disciplines. Presented properties and complications of robotic surgery reported in this study, may be helpful for anesthesiologists and surgeons.

PDF

___

1. Palep JH. Robotic assisted minimally invasive surgery. J Minim Access Surg 2009;5:1-7.

2. Zmora O, Gervaz P, Wexner SD. Trocar site recurrence in laparoscopic surgery for colorectal cancer. Surg Endosc. 2001;15:788-93.

3. Irvine M, Patil V. Anaesthesia for robot-assisted laparoscopic surgery. Contin Educ Anaesth Crit Care Pain. 2009;9:125-9.

4. Sullivan MJ, Frost EA, Lew MW. Anesthetic care of the patient for robotic surgery. Middle East J Anesthesiol. 2008;19:967-82.

5. Gainsburg DM, Wax D, Reich DL, Carlucci JR, Samadi DB. Intraoperative management of robotic-assisted versus open radical prostatectomy. JSLS. 2010;14:1-5.

6. Pandey R, Garg R, Roy K, Darlong V, Punj J, Kumar A. Perianesthetic management of the first robotic partial cystectomy in bladder pheochromocytoma. A case report. Minerva Anestesiol. 2010;76:294-7.

7. Schrijvers D, Mottrie A, Traen K, De Wolf AM, Vandermeersch E, Kalmar AF, et al. Pulmonary gas exchange is well preserved during robot assisted surgery in steep Trendelenburg position. Acta Anaesthesiol Belg. 2009;60:229-33.

8. Kibar Y, Yalçın S, Kaya E, Köprü B, Ebiloğlu T, Ergin G, et al. Our experiences with robot- assisted laparoscopic surgery in pediatric patients: the first case series from Turkey. Turk J Urol. 2017;43:355-60.

9. Holmberg L, Bill-Axelson A, Helgesen F, Salo JO, Folmerz P, Häggman M, et al. A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer. N Engl J Med. 2002; 347:781–789.

10. Awad H, Walker CM, Shaikh M, Dimitrova GT, Abaza R, O’Hara J. Anesthetic considerations for robotic prostatectomy: a review of the literature. J Clin Anesth. 2012;24:494-504.

11. Mcalpine K, Forster Md AJ, Breau RH, et al. Robotic surgery improves transfusion rate and perioperative outcomes using a broad implementation process and multiple surgeon learning curves. Can Urol Assoc J 2018. Epub ahead of print

12. Danic MJ, Chow M, Alexander G, et al. Anesthesia considerations for robotic-assisted laparoscopic prostatectomy: a review of 1,500 cases. J Robot Surg. 2007;1:119-23.

13. Ou YC, Yang CK, Chang KS, et al. Prevention and management of complications during robotic-assisted laparoscopic radical prostatectomy following comprehensive planning: A large series involving a single surgeon. Anticancer Res 2016;36:1991-8.

14. Albright BB, Witte T, Tofte AN, et al. Robotic Versus Laparoscopic Hysterectomy for Benign Disease: A Systematic Review and Meta-Analysis of Randomized Trials. J Minim Invasive Gynecol. 2016;23:18-27.

15. Mäenpää MM, Nieminen K, Tomás EI, et al. Robotic-assisted vs traditional laparoscopic surgery for endometrial cancer: a randomized controlled trial. Am J Obstet Gynecol 2016;215:588.e1-7.

16. Matanes E, Weissman A, Rivlin A, et al. The effects of pneumoperitoneum and the steep Trendelenburg position on heart rate variability and cerebral oxygenation during robotic sacrocolpopexy. J Minim Invasive Gynecol 2018;25:70-5.

17. Ackerman RS, Cohen JB, Getting REG, et al. Are you seeing this: the impact of steep Trendelenburg position during robot-assisted laparoscopic radical prostatectomy on intraocular pressure: a brief review of the literature. J Robot Surg 2018. Epub ahead of print

18. Rausa E, Kelly ME, Asti E, et al. Right hemicolectomy: a network meta-analysis comparing open, laparoscopic-assisted, total laparoscopic, and robotic approach. Surg Endosc 2018. Epub ahead of print

19. Jung M, Morel P, Buehler L, et al. Robotic general surgery: current practice, evidence, and perspective. Langenbecks Arch Surg. 2015;400:283-92.

20. Pinar I, Fransgaard T, Thygesen LC, et al. Long-term outcomes of robot-assisted surgery in patients with colorectal cancer. Ann Surg Oncol. 2018;25:3906-12.

21. Patriti A, Ceccarelli G, Bartoli A, et al. Short- and medium-term outcome of robot assisted and traditional laparoscopic rectal resection. JSLS. 2009;13:176-83.

22. Somashekhar SP AK, Rajashekhar J, Zaveri S. Prospective randomized study comparing robotic-assisted surgery with traditional laparotomy for rectal cancer—Indian study. Indian J Surg. 2015;77:788-94.

23. Mégevand JL, Amboldi M, Lillo E, et al. Right colectomy: consecutive 100 patients treated with laparoscopic and robotic technique for malignancy. Cumulative experience in a single centre. Updates Surg. 2018. Epub ahead of print

24. Spinoglio G, Bianchi PP, Marano A, et al. Robotic versus laparoscopic right colectomy with complete mesocolic excision for the treatment of colon cancer: perioperative outcomes and 5-year survival in a consecutive series of 202 patients. Ann Surg Oncol. 2018;25:3580-6.

25. Muderris T, Sevil E, Bercin S, et al. Transoral robotic lingual tonsillectomy in adults: preliminary results. Acta Otolaryngol. 2015;135:64-9.

26. Montevecchi F, Cammaroto G, Meccariello G, et al. Trans-oral robotic surgery (TORS) for the treatment of lingual tonsillitis. When conventional therapies fail. Int J Med Robot 2017. Epub ahead of print 2016 Aug 2.