Prolonged intraperitoneal versus extraperitoneal insufflation of carbon dioxide in patients undergoing totally endoscopic robot-assisted radical prostatectomy

Background: Extraperitoneal laparoscopic prostatectomy is an alternative to the intraperitoneal method. However, the effects of extraperitoneal carbon dioxide (CO2) insufflation on hemodynamics and respiratory data have not been adequately studied. This study compared the effects of prolonged intra- and extraperitoneal CO2 insufflation on hemodynamics and gas exchange. Methods: For this study, 20 patients were assigned to receive totally endoscopic robot-assisted radical prostatectomy (TERP) via the intra- or extraperitoneal approach. Hemodynamic parameters and respiratory data were obtained during 8 h of insufflation and analyzed for statistical differences. Results: With both insufflation methods, arterial CO2 pressure increased rapidly, reaching higher levels with extraperitoneal insufflation. Therefore, patients managed with extraperitoneal insufflation required a significantly higher minute ventilation. Heart rate and central venous pressure increased in both groups, whereas mean arterial blood pressure and pH decreased. Conclusions: Prolonged intra- and extraperitoneal CO2 insufflation for TERP resulted in significant, but mostly clinically unimportant, hemodynamic alterations. Carbon dioxide absorption was more pronounced with extraperitoneal insufflation.