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Related Experiment Video

Updated: Jun 23, 2025

Retzius-Sparing Robot-Assisted Radical Prostatectomy
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Mechanical power during robotic-assisted laparoscopic prostatectomy: an observational study.

Tommaso Pozzi1, Silvia Coppola2, Giulia Catozzi1

  • 1Department of Health Sciences, University of Milan, Milan, Italy.

Journal of Clinical Monitoring and Computing
|June 17, 2024
PubMed
Summary

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Robotic-assisted radical prostatectomy (RALP) significantly increases mechanical power due to pneumoperitoneum and Trendelenburg positioning. Positive end-expiratory pressure (PEEP) further elevates this power without improving respiratory system elastance.

Area of Science:

  • Anesthesiology
  • Surgical Innovation
  • Respiratory Mechanics

Background:

  • Robotic-assisted laparoscopic radical prostatectomy (RALP) necessitates pneumoperitoneum and steep Trendelenburg positioning.
  • The combined effects of these surgical conditions on respiratory mechanics, specifically mechanical power, require investigation.

Purpose of the Study:

  • To evaluate the impact of pneumoperitoneum and Trendelenburg position on mechanical power and its components during RALP.
  • To assess the influence of positive end-expiratory pressure (PEEP) on mechanical power in this context.

Main Methods:

  • Prospective study of 61 patients undergoing RALP.
  • Measurements of mechanical power in supine position (pre- and post-surgery) and during pneumoperitoneum with Trendelenburg position.
Keywords:
Intraoperative mechanical ventilationMechanical PowerRobotic Surgery

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  • Subgroup analysis (17 patients) examining the effect of increasing PEEP from 5 to 10 cmH2O.

    • Main Results:

    • Pneumoperitoneum and Trendelenburg position significantly increased total mechanical power (13.8 J/min) compared to pre-surgery supine position (9.2 J/min).
    • Post-surgery supine position showed decreased but still elevated mechanical power compared to pre-surgery.
    • Increasing PEEP significantly augmented mechanical power at all measurement points without altering respiratory system elastance.

    Conclusions:

    • Mechanical power is significantly elevated during and after RALP procedures involving pneumoperitoneum and Trendelenburg positioning.
    • PEEP consistently increases mechanical power, highlighting potential implications for ventilator-induced lung injury, without improving respiratory system elastance.