Figen ÖZTÜRK, Yasemin TEKDÖŞ ŞEKER, Nalan Saygı EMİR, Oya HERGÜNSEL, Derya MANDACI, Evrim TÜLÜBAŞ

The experience of anesthesia during kidney transplantation with robot assisted laparoscopic surgery

Objective: Renal transplantation is the most commonly used method to improve the quality of life of patientswith end-stage renal failure. Kidney transplantation began in our hospital in 2016 with robot-assistedlaparoscopic surgery (RALS). Here, we retrospectively compared the RALS technique and open surgery withrespect to anesthesia management during kidney transplant operations done in our clinic.Methods: Anesthesia management, the duration of the operation and of vascular anastomosis, the amount offluid delivered perioperatively, amount of urine, and diuretic requirements were investigated retrospectivelyin cases of renal transplantation (Group O, open surgical technique, n = 22; Group R, RALS technique, n =14). Blood gas values, and lactate, bicarbonate, glucose, and electrolyte levels, were examined preoperativelyafter extubation.Results: The durations of surgery and vascular anastomosis were significantly longer in Group R than in GroupO (p < 0.05). Perioperative liquid volume was not significantly different between Groups R and A. Postoperativesystolic arterial pressure was significantly higher in Group R than in Group O. As venous blood samples wereobtained in Group O and arterial blood samples were obtained in Group R, blood gas parameters were evaluatedwithin, but not between, groups. The pH and HCO3 values at the end of the operation were significantly lower,while the lactate level was significantly higher, in Group O compared to Group R (p < 0.001). There was asignificant decrease in calcium level at the end of the operation versus pre-anesthesia induction in Group O,but no significant increase in the glucose level was found. There were no significant differences in sodium orpotassium levels within or between the groups (p > 0.05).Conclusions: The surgical superiority of RALS technique is known. However, anesthesia management in thispatient group is difficult due to the risk of the Trendelenburg position and pneumoperitoneum.

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