Intraoperative Ventilatory Pressures During Robotic Assisted vs Open Radical Cystectomy

To investigate whether Robotic assisted radical cystectomy (RARC) is associated with increased postoperative pulmonary complications compared to open radical cystectomy (ORC). RARC poses challenges for ventilation with positioning and abdominal insufflation. Conventionally protective mechanical ventilation may be challenging, especially in patients with obesity or pulmonary comorbidities. Given the proven benefits of RARC compared to ORC, the risk of postoperative pulmonary complications merits further investigation.

Adult patients consented for research who underwent RARC and ORC for invasive bladder cancer from 2013-2018 were identified for retrospective chart review. Perioperative and patient variables were looked at along with postoperative course and outcomes.

328 patients who underwent ORC and 108 patients who underwent RARC were identified. Despite findings of higher peak airway pressures throughout surgery, patients who underwent RARC did not have a higher rate of pulmonary complications than patients who underwent ORC. Patients with obstructive sleep apnea (OSA) who underwent ORC had a higher rate of postoperative pulmonary complications. Patients who underwent RARC had a less intraoperative fluid administration, fewer ICU admissions, and decreased length of hospital stay.

Despite mechanical ventilation challenges, RARC was not associated with increased post-operative pulmonary complications compared to ORC. This was also found in patients with BMI>30 or with diagnosis or high suspicion of OSA. These findings suggest ventilation at higher pressures does not increase risk for ventilator induced lung injury in patients undergoing RARC, even in conventionally higher risk patients.