Low- versus standard- pneumoperitoneum in patients undergoing robot-assisted radical prostatectomy: a randomised,triple-blinded study |
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Authors: | Hayder Alhusseinawi Lotte Sander Pernille M Rosenvinge Sarah L Jensen Niels Henrik Bruun Pernille S Kingo Jørgen B Jensen Sten Rasmussen |
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Institution: | 1. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark;2. Department of Urology, Aalborg University Hospital, Aalborg, Denmark;3. Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark;4. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Department of Urology, Aarhus University Hospital, Aarhus, Denmark |
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Abstract: | Objective To investigate the effectiveness and impact of low-pressure pneumoperitoneum (Pnp) on postoperative quality of recovery (QoR) and surgical workspace (SWS) in patients with prostate cancer undergoing robot-assisted radical prostatectomy (RARP). Patients and Methods A randomised, triple-blinded trial was conducted in a single centre in Denmark from March 2021 to January 2022. A total of 98 patients with prostate cancer undergoing RARP were randomly assigned to either low-pressure Pnp (7 mmHg) or standard-pressure Pnp (12 mmHg). Co-primary outcomes were postoperative QoR measured via the QoR-15 questionnaire on postoperative Day 1 (POD1), POD3, POD14, and POD30, and SWS assessed intraoperatively by a blinded assessor (surgeon) via a validated SWS scale. Data analysis was performed according to the intention-to-treat principle. Results Patients who underwent RARP at low Pnp pressure demonstrated better postoperative QoR on POD1 (mean difference = 10, 95% confidence interval CI] 4.4–15.5), but no significant differences were observed in the SWS (mean difference = 0.25, 95% CI −0.02 to 0.54). Patients allocated to low-pressure Pnp experienced statistically higher blood loss than those in the standard-pressure Pnp group (mean difference = 67 mL, P = 0.01). Domain analysis revealed significant improvements in pain (P = 0.001), physical comfort (P = 0.007), and emotional state (P = 0.006) for patients with low-pressure Pnp. This trial was registered at ClinicalTrials.gov , NCT04755452, on 16/02/2021. Conclusion Performing RARP at low Pnp pressure is feasible without compromising the SWS and improves postoperative QoR, including pain, physical comfort, and emotional state, compared to the standard pressure. |
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Keywords: | postoperative recovery quality of recovery QoR-15 surgical workspace RARP low pneumoperitoneum |
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