Abstract
To evaluate the role of low intra-abdominal pressure (IAP) in improving postoperative recovery in Robotic-assisted radical cystectomy (RARC) and intracorporeal conduit urinary diversion (ICUD).
Methods
A retrospective case-control study of 49 bladder cancer patients offered RARC/ICUD with standard (12mmHg, n=24) or low IAP (8mmHg, n=25).
Outcomes of interest included length of procedure (LoP), estimated blood loss (EBL), blood transfusion, margin positivity rates, time to first flatus (TtFF), time to first bowel movement (TtFBM), ileus and small bowel obstruction (SBO) rates, time to safe discharge (TtSD), postoperative hospital stay (PHS) and pain levels on postoperative day (POD) 1 and 3. Perioperative complications were recorded using the Clavien-Dindo system.
Results
Demographic and baseline clinical characteristics, LoP, EBL and margin positivity rates were similar between groups. No transfusions were recorded. Median (IQR) TtFF, TtFBM and TtSD were significantly longer in Group 1 vs Group 2 (4 (1) vs 2 (1), 7 (3) vs 6 (2) and 8.5 (5.75) vs 5.0 (1), respectively). PHS and rates of postoperative ileus and SBO were lower in Group 2, however not statistically significant.
Severe pain was uncommon in both groups but moderate/severe pain were significantly higher in Group 1 (95.8% vs 48% on POD1 and 62.5% vs 16% on POD3). No significant intraoperative complications were recorded and ≥Grade 3 postoperative complications at 30 and 90 days were similar.
Conclusion
With limitations, Low-IAP RARC can be safely offered to RARC/ICUD patients and leads to faster bowel recovery, and shorter time to safe discharge compared to standard pneumoperitoneum.
| Original language | English |
|---|---|
| Pages (from-to) | 2467-2472 |
| Number of pages | 6 |
| Journal | World Journal of Urology |
| Volume | 40 |
| Issue number | 10 |
| Early online date | 5 Sept 2022 |
| DOIs | |
| Publication status | Published - Oct 2022 |
Keywords
- Low-pressure
- pneumoperitoneum
- intra-abdominal pressure
- robotic
- radical cystectomy
- intracorporeal urinary diversion
Access to Document
- Kostakopoulos_etal_MedEd_theImpactofLow-Pressure_VOR
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