BP, Fluid Management Improve With Robotic Laparoscopic Prostatectomy

The benefits of robot-assisted laparoscopic prostatectomy (RALP) have been clouded by doubts about its effect on blood pressure and fluid management, but a new study has found that RALP reduced the volume of fluids and alleviated the need for blood transfusion compared with open radical prostatectomy.

According to Hidehisa Saito, MD, a resident at the Tohoku University School of Medicine, in Sendai, Japan, despite RALP’s increasing popularity, anesthesiologists are wary of the technique because its steep Trendelenburg position has been shown to increase blood pressure.

To examine this, Dr. Saito and his colleagues retrospectively studied 296 patients who underwent either RALP or open radical prostatectomy at their institution between Nov. 1, 2011 and Oct. 31, 2015.

After propensity-score matching, the investigators compared metrics between the groups, including total infusion volume, total amount of colloids infused, blood loss, and use and type of blood transfusion.

The total infusion volume was significantly less in RALP patients (2,115±563 mL) than those who underwent open radical prostatectomy (4,175±1,374 mL; P<0.01). Similarly, the total volume of colloids administered to RALP patients was significantly less than in the radical prostatectomy group (0±500 vs. 1,000±63 mL; P<0.01).

Blood loss was found to be significantly less in patients who underwent the robot-assisted procedure (253±297 vs. 815±754 mL; P<0.01). Not surprisingly, transfusion was administered to none of the patients who underwent RALP, whereas 46 of their radical prostatectomy counterparts (64%) received autologous transfusions (P<0.01). Homologous transfusion was administered to no RALP patient and six radical prostatectomy patients (8%; P<0.05). The results of the linear regression model proved similar (Table).

Table. Volume Parameters Using Robotic Prostatectomy Compared With Open Radical Prostatectomy Absolute Difference 95% CI P Value Total infusion, mL –1,077 –1,151 to –1,033 <0.0001 Total colloids, mL –438 –476 to –400 <0.0001 Blood loss, mL –439 –510 to –368 <0.0001

“These findings suggest that the introduction of robotic surgery can lead to the evolution of fluid and transfusion management strategies,” said Dr. Saito, who originally reported his findings at the 2016 annual meeting of the American Society of Anesthesiologists (abstract A2107).