학술논문
ANESTHESIA FOR ROBOT-ASSISTED RADICAL PROSTATECTOMY - A CHALLENGE FOR ANAESTHESIOLOGIST/ANESTEZIJA ZA ROBOT-ASISTIRANU RADIKALNU PROSTATEKTOMIJU - IZAZOV ZA ANESTEZIOLOGA
Professional Paper
Professional Paper
Document Type
Report
Author
Source
Acta Clinica Croatica. December 15, 2022, Vol. 61 Issue S3, p76, 5 p.
Subject
Language
English
ISSN
0353-9466
Abstract
Introduction Many advantages have made it possible for minimally invasive surgery to become one of the most popular surgeries'. Some of the benefits are reduced postoperative pain and blood loss, [...]
Mininimally invasive surgery has become one of the most popular ones over the last few decades due to many benefits. The advantages are minimal surgical incision, reduced blood loss, reduced postoperative pain, faster postoperative recovery, shorter hospital stay, lower morbidity and better outcomes compared to open surgery. The most common robotic procedures in urology are radical prostatectomies. In UHC Zagreb, since November 2019 until now, there have been more than 180 robotic assisted radical prostatectomies (RALP) using Senhance robotic system performed. As a procedure with many possible complications, it represents a challenge for anaesthesiologist. Some of the problems the anaesthesiologists have to face are related to limited patient access, possible difficulties connected with positioning, pneumoperitoneum, subcutaneous emphysema, possible airway oedema. Pneumoperitoneum has impact on almost every system: cardiovascular, renal, respiratory, gastrointestinal and other. Detailed understanding of physiological changes of RALP, with intraoperative impact on nearly every body system is ultimate. Careful preoperative evaluation and intraoperative conduction minimize the risk of complications, and help patients to reach full recovery in a very short time. Excellent outcomes are the result of individualized approach to the patient and good communication between team members. Keywords: radical prostatectomy, robotic surgery, anaesthesia, perioperative management Zbog brojnih prednosti, minimalno invazivna kirurgija postala je u posljednjih nekoliko godina jedna od najpopularnijih grana kirurgije. Prednosti su minimalan kirurski rez, manje krvarenja. bolja postoperativna analgezija, brzi postoperacijski oporavak, kraca hospitalizacija, niza smrtnost i bolji ishod u usporedbi s otvorenim zahvatima. Najcesci robotski asistiran zahvat u urologiji je radikalna prostatektomija. U KBC Zagreb, od rujna 2019 do danas ucinjeno je vise od 180 robotski asitiranih radikalnih prostatektomija (RALP) uz Senhance sustav. RALP je zahvat s dosta potencijalnih komplikacija, te predstavlja izazov za anesteziologa. Neki od problema s kojima se anesteziolog susreceje ogranicen pristup bolesniku na operacijskom stolu, polozaj bolesnika na operacijskom stoplu, pneumoperitoneum, subkutani emfizem, moguci razvoj edema disnog puta. Pneumoperitoneum moze imati utjecaj na gotove sve organske sustave: Kardiovaskularni, plucni, bubrezni, gastrointestinalni i drugi. Vazno je dobro razumjeti fizioloske promjene tijekom pneumoperitoneuma intraoperacijski. Pazljivom preoperacijskom obradom i intaroperacijskim vodenjem anestezije, smanjuje se moguci broj komplikacija te ubrzava oporavakpacijenta u kratkom periodu. Odlican ishod rezultat je individualiziranog pristupa pacijentu i dobre komunikacije izmedu clanova operacijskog tima. Kljucne rijeci: Radikalna prostatektomija, robotska kirurgija, anestezija, perioperativno postupanje
Mininimally invasive surgery has become one of the most popular ones over the last few decades due to many benefits. The advantages are minimal surgical incision, reduced blood loss, reduced postoperative pain, faster postoperative recovery, shorter hospital stay, lower morbidity and better outcomes compared to open surgery. The most common robotic procedures in urology are radical prostatectomies. In UHC Zagreb, since November 2019 until now, there have been more than 180 robotic assisted radical prostatectomies (RALP) using Senhance robotic system performed. As a procedure with many possible complications, it represents a challenge for anaesthesiologist. Some of the problems the anaesthesiologists have to face are related to limited patient access, possible difficulties connected with positioning, pneumoperitoneum, subcutaneous emphysema, possible airway oedema. Pneumoperitoneum has impact on almost every system: cardiovascular, renal, respiratory, gastrointestinal and other. Detailed understanding of physiological changes of RALP, with intraoperative impact on nearly every body system is ultimate. Careful preoperative evaluation and intraoperative conduction minimize the risk of complications, and help patients to reach full recovery in a very short time. Excellent outcomes are the result of individualized approach to the patient and good communication between team members. Keywords: radical prostatectomy, robotic surgery, anaesthesia, perioperative management Zbog brojnih prednosti, minimalno invazivna kirurgija postala je u posljednjih nekoliko godina jedna od najpopularnijih grana kirurgije. Prednosti su minimalan kirurski rez, manje krvarenja. bolja postoperativna analgezija, brzi postoperacijski oporavak, kraca hospitalizacija, niza smrtnost i bolji ishod u usporedbi s otvorenim zahvatima. Najcesci robotski asistiran zahvat u urologiji je radikalna prostatektomija. U KBC Zagreb, od rujna 2019 do danas ucinjeno je vise od 180 robotski asitiranih radikalnih prostatektomija (RALP) uz Senhance sustav. RALP je zahvat s dosta potencijalnih komplikacija, te predstavlja izazov za anesteziologa. Neki od problema s kojima se anesteziolog susreceje ogranicen pristup bolesniku na operacijskom stolu, polozaj bolesnika na operacijskom stoplu, pneumoperitoneum, subkutani emfizem, moguci razvoj edema disnog puta. Pneumoperitoneum moze imati utjecaj na gotove sve organske sustave: Kardiovaskularni, plucni, bubrezni, gastrointestinalni i drugi. Vazno je dobro razumjeti fizioloske promjene tijekom pneumoperitoneuma intraoperacijski. Pazljivom preoperacijskom obradom i intaroperacijskim vodenjem anestezije, smanjuje se moguci broj komplikacija te ubrzava oporavakpacijenta u kratkom periodu. Odlican ishod rezultat je individualiziranog pristupa pacijentu i dobre komunikacije izmedu clanova operacijskog tima. Kljucne rijeci: Radikalna prostatektomija, robotska kirurgija, anestezija, perioperativno postupanje