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Robotics in Surgery: A Modular Robotic Platform Driven Gastric Wedge Resection
Published on: February 7, 2025
Driving pressure guided ventilation in robot-assisted laparoscopic surgery with steep Trendelenburg position: a
Sooah Cho1, Bo Rim Kim2, Sang-Youn Park1
1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.
Background:
Robot-assisted laparoscopic prostatectomy (RALP) with pneumoperitoneum and steep Trendelenburg positioning impairs ventilation and increases the risk of postoperative pulmonary complications (PPCs). Although positive end-expiratory pressure (PEEP) may reduce atelectasis, the optimal levels remain unclear. This study evaluated the effects of driving pressure (DP)-guided PEEP titration during RALP.
Methods:
This single-center, randomized controlled trial enrolled adults undergoing RALP (American Society of Anesthesiologists < 3, without pulmonary disease) for either DP minimization-guided individualized PEEP (DP group) or fixed 5 cmH2O PEEP (control). DP was calculated as plateau pressure minus PEEP, with individualized PEEP determined using decremental titration. Atelectasis was quantified using modified lung ultrasound (LUS) score, incorporating B-lines and consolidations. Primary outcome was LUS score at end-Trendelenburg. Secondary outcomes included oxygenation and PPCs.
Results:
Of 101 assessed, 63 completed analysis. The DP group (n=31) received higher individualized PEEP (median 8.0 cmH2O) during Trendelenburg than controls (5.0 cmH2O, n=32). In the DP group, mean DP was lower during Trendelenburg (19.0 ± 3.4 vs. 21.3 ± 4.7 cmH2O, P=0.035) and LUS score was significantly lower at the end-Trendelenburg (median [1Q, 3Q]: 9.0 [8.0, 11.5] vs. 11.0 [9.0, 13.0]; median difference, -2.0 [95% CI, -3.0 to 0.0]; P=0.032) and recovery (9.0 vs. 13.5, P<0.001). Intraoperative PaO2 during Trendelenburg was higher in the DP group (154.6 ± 33.1 vs. 133.3 ± 34.7 mmHg, P=0.015). PPCs and hospital stay were comparable between groups.
Conclusions:
DP-guided PEEP titration during RALP reduced lung de-aeration burden assessed by modified LUS score, though benefits did not translate to reduced PPCs.
