Postoperative Pulmonary Complications in Conventional Laparoscopic vs Robot-Assisted Abdominal Surgery

Area of Science:

• Surgery
• Anesthesiology
• Pulmonary Medicine

Background:

• Robot-assisted surgery (RAS) is increasingly adopted for abdominal procedures.
• Postoperative pulmonary complications (PPCs) are more frequent after RAS compared to conventional laparoscopic surgery (CLS).

Purpose of the Study:

• To compare the incidence of PPCs between CLS and RAS.
• To identify patient, surgery, and anesthesia factors associated with PPCs.

Main Methods:

• A multinational cohort study utilizing the Laparoscopic and Robot-Assisted Surgery (LapRAS) database.
• Included adult patients undergoing CLS or RAS requiring intraoperative ventilation.
• Analyzed surgical approach, ventilation duration, and intensity (4DP+RR) as exposures.

Main Results:

• PPCs occurred in 19.0% of RAS patients versus 9.5% of CLS patients.
• RAS involved longer intraoperative ventilation (219 vs 95 minutes) and higher ventilation intensity.
• Only duration of ventilation independently predicted PPCs (aOR, 1.49; P<.001), not surgical approach or ventilation intensity.

Conclusions:

• The higher incidence of PPCs in RAS is primarily linked to longer ventilation duration, not the surgical approach itself.
• Focusing on reducing intraoperative ventilation duration may mitigate PPCs in RAS.
• Further research may explore the interaction between ventilation intensity and procedure duration.