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Unexpected hemorrhage during robot-assisted laparoscopic prostatectomy: a case report
Shoko Nakano1, Junko Nakahira2, Toshiyuki Sawai1
1Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
Journal of Medical Case Reports
|September 1, 2016
Summary
During robot-assisted prostatectomy, steep head-down positioning masked a surgical hemorrhage. The bleeding became apparent only when the patient was repositioned, highlighting risks of hemodynamic changes.
Area of Science:
- Urology
- Surgical Oncology
- Anesthesiology
Background:
- Robot-assisted laparoscopic prostatectomy is a minimally invasive treatment for organ-confined prostate cancer.
- Steep head-down tilt is a common but potentially risky positioning during this procedure.
- Concerns exist regarding the hemodynamic effects of head-down tilt and pneumoperitoneum.
Observation:
- A 73-year-old man experienced severe hypotension during robot-assisted prostatectomy.
- Blood pressure initially remained stable despite decreasing values due to head-down tilt and insufflation.
- Hypotension rapidly worsened upon returning to a horizontal position and ceasing insufflation.
Findings:
- The patient had an intraoperative hemorrhage from an arterial vessel in the abdominal wall.
- Increased intra-abdominal pressure from insufflation likely tamponaded the bleeding.
- Abrupt cessation of insufflation and repositioning led to uncontrolled hemorrhage and sudden blood pressure drop.
Implications:
- Surgeons and anesthesiologists must recognize that head-down tilt and pneumoperitoneum can mask intraoperative bleeding.
- Careful hemodynamic monitoring is crucial during and after changes in patient positioning and insufflation.
- Understanding these effects is vital for patient safety in robot-assisted procedures.
