-Original-

Effect of Robot-assisted Surgery on Anesthetic and Perioperative Management for Minimally Invasive Radical Prostatectomy under Combined General and Epidural Anesthesia

Hiroaki Kishikawa¹, Norihito Suzuki¹, Yasutomo Suzuki², Tsutomu Hamasaki², Yukihiro Kondo² and Atsuhiro Sakamoto¹

¹Department of Anesthesiology, Nippon Medical School, Tokyo, Japan
²Department of Urology, Nippon Medical School, Tokyo, Japan

Background: Robot-assisted surgery and pure laparoscopic surgery are available for minimally invasive radical prostatectomy (MIRP). The differences in anesthetic management between these two MIRPs under combined general and epidural anesthesia (CGEA) remain unknown. This study therefore aimed to determine the effects of robot-assisted surgery on anesthetic and perioperative management for MIRP under CGEA.
Methods: This retrospective observational study analyzed data from patients' electronic medical records. Data on demographics, intraoperative variables, postoperative complications, and hospital stays after MIRPs were compared between patients who underwent robot-assisted laparoscopic radical prostatectomy (RALP) and those treated by pure laparoscopic radical prostatectomy (LRP).
Results: There were no differences in background data between the 102 who underwent RALP and 112 who underwent LRP. Anesthesia and surgical times were shorter in the RALP group than in the LRP group. Doses of anesthetics, including intravenous opioids, and epidural ropivacaine, were lower in the RALP group. Although estimated blood loss and volume of colloid infusion were lower in the RALP group, the volume of crystalloid infusion was larger. Intraoperative allogeneic transfusion was not required in either group. There was no difference between groups in the incidences of postoperative cardiopulmonary complications or postoperative nausea and vomiting. Hospital stays after the procedure were shorter in the RALP group.
Conclusions: Robot-assisted surgery required varied consumption of anesthetics and infusion management during MIRP under GCEA. It also shortened postoperative hospital stays, without increasing rates of postoperative complications.

J Nippon Med Sch 2021; 88: 121-127

Keywords
anesthetic and perioperative management, minimally invasive radical prostatectomy, robot-assisted surgery, pure-laparoscopic surgery, combined general and epidural anesthesia

Correspondence to
Hiroaki Kishikawa, Department of Anesthesiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
h-k@nms.ac.jp

Received, February 22, 2020
Accepted, May 1, 2020