Association Between Acute Kidney Injury and the Trendelenburg Position Angle During Robot-assisted Radical...

Area of Science:

• Urology
• Nephrology
• Surgical Innovation

Background:

• Robot-assisted radical prostatectomy (RARP) is a standard treatment for localized prostate cancer, offering advantages over open surgery.
• Concerns exist regarding acute kidney injury (AKI) associated with RARP, potentially due to carbon dioxide pneumoperitoneum and steep Trendelenburg positioning.

Purpose of the Study:

• To investigate the incidence of AKI following RARP.
• To determine the relationship between Trendelenburg position angle and AKI incidence during RARP.

Main Methods:

• A study involving 77 patients undergoing RARP.
• Patients were divided into two groups based on Trendelenburg position angle: 20 degrees (Group A) and 25 degrees (Group B).
• Serum creatinine levels were monitored pre-surgery, and on postoperative days 0, 1, and 6 to assess kidney function.

Main Results:

• The incidence of AKI on postoperative day 0 was significantly lower in the 25-degree Trendelenburg group (Group B) compared to the 20-degree group (Group A).
• All patients showed improved renal function to preoperative levels by postoperative day 6.
• Hypertension was identified as a predictor for immediate postoperative AKI.

Conclusions:

• A Trendelenburg position angle of 25 degrees during RARP is associated with a lower incidence of immediate postoperative AKI compared to 20 degrees.
• The observed AKI was temporary, with renal function recovering by postoperative day 6.
• Hypertension is a significant predictor of AKI in the immediate postoperative period following RARP, and a 25-degree Trendelenburg angle is recommended.