The displacement of the tracheal tube during robot-assisted radical prostatectomy

Robot-assisted prostatectomy requires pneumoperitoneum in a steep Trendelenburg position, which may induce endobronchial intubation or accidental extubation. The aim of the study was to evaluate the effect of pneumoperitoneum in 30 degrees Trendelenburg position on the displacement of the tracheal tube and to measure the changes in trachea length using fiberoptic bronchoscope.

Thirty male patients scheduled for robot-assisted radical prostatectomy were enrolled. After induction of general anaesthesia, the distance between the vocal cords and the tracheal tube tip (DeltaVE), between the tracheal tube tip and the carina (DeltaEC) and between the vocal cords and the carina (DeltaVC) was measured using a fiberoptic bronchoscope before and 10 min after pneumoperitoneum in neutral position (T1 and T2, respectively), and 2 h after pneumoperitoneum in 30 degrees Trendelenburg position (T3).

The DeltaVC and DeltaEC decreased significantly 10 min after pneumoperitoneum in neutral position (T2) and 2 h after pneumoperitoneum in Trendelenburg position (T3) compared with those before pneumoperitoneum in neutral position (T1) (all P < 0.001). The changes in DeltaVE were not statistically significant.

The confirmation of the tracheal tube position is recommended after pneumoperitoneum in steep Trendelenburg position during robot-assisted prostatectomy because the displacement of the tracheal tube may result in endobronchial intubation due to shortening of the carina-to-tube tip distance.