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End-Tidal CO2 During Enhanced-View Totally Extraperitoneal Hernia Repair: A Comparison of Retrorectus and
Ashley Huggins1, Cameron Casson2, Bradley Kushner2
1Washington University in St. Louis School of Medicine, St. Louis, Missouri.
The Journal of Surgical Research
|September 10, 2024
Summary
Enhanced-view totally extraperitoneal (eTEP) repairs show higher end-tidal CO2 (ETCO2) due to retrorectus insufflation compared to robotic transversus abdominis release (r-TAR). However, this did not impact patient outcomes, highlighting the need for anesthesia communication.
Area of Science:
- Minimally Invasive Surgery
- Surgical Oncology
- Anesthesiology
Background:
- The enhanced-view totally extraperitoneal (eTEP) approach is safe and effective for ventral hernia repair.
- The impact of retrorectus insufflation during eTEP on respiratory parameters like end-tidal CO2 (ETCO2) remains unclear.
Purpose of the Study:
- To compare intraoperative respiratory stability, specifically ETCO2 levels, between eTEP and robotic transversus abdominis release (r-TAR) hernia repairs.
- To evaluate the relationship between retrorectus insufflation and respiratory parameters in eTEP procedures.
Main Methods:
- Retrospective chart review of patients undergoing robotic-assisted ventral hernia repair (eTEP or r-TAR).
- Analysis of anesthesia records, including ETCO2 and respiratory rate, at standardized intervals.
- Comparison of operative time, length of stay, and perioperative complications between the two groups.
Main Results:
- eTEP repairs exhibited significantly higher ETCO2 levels at the start of the procedure compared to r-TAR.
- A transient increase in respiratory rate was observed during eTEP procedures.
- eTEP was associated with shorter operative times, reduced patient-controlled anesthesia use, and shorter hospital stays without increased respiratory complications.
Conclusions:
- Retrorectus insufflation in eTEP repairs is linked to elevated ETCO2 but does not adversely affect perioperative outcomes.
- Anesthesiologists should be aware of potential respiratory changes during eTEP for appropriate ventilation management.
- eTEP offers potential benefits in terms of operative efficiency and patient recovery.
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