The experience of anesthesia during kidney transplantation with robot assisted laparoscopic surgery

Year 2018, Volume: 4 Issue: 4, 300 - 307, 04.10.2018

Yasemin Tekdöş Şeker , Nalan Saygı Emir Oya Hergünsel Evrim Tülübaş Figen Öztürk Derya Mandacı

https://doi.org/10.18621/eurj.356547

Cited By: 1

Abstract

Objective: Renal transplantation is the most commonly
used method to improve the quality of life of patients with end-stage renal
failure. Kidney transplantation began in our hospital in 2016 with
robot-assisted laparoscopic surgery (RALS). Here, we retrospectively compared
the RALS technique and open surgery with respect to anesthesia management
during kidney transplant operations done in our clinic.

Methods: Anesthesia
management, the duration of the operation and of vascular anastomosis, the
amount of fluid delivered perioperatively, amount of urine, and diuretic
requirements were investigated retrospectively in cases of renal
transplantation (Group O, open surgical technique, n = 22; Group R, RALS technique, n = 14). Blood gas values, and lactate, bicarbonate,
glucose, and electrolyte levels, were examined preoperatively after extubation.

Results:
The durations of surgery and vascular anastomosis were significantly longer in
Group R than in Group O (p < 0.05).
Perioperative liquid volume was not significantly different between Groups R
and A. Postoperative systolic arterial pressure was significantly higher in
Group R than in Group O. As venous blood samples were obtained in Group O and
arterial blood samples were obtained in Group R, blood gas parameters were
evaluated within, but not between, groups. The pH and HCO₃ values at
the end of the operation were significantly lower, while the lactate level was
significantly higher, in Group O compared to Group R (p < 0.001). There was a significant decrease in calcium level at
the end of the operation versus pre-anesthesia induction in Group O, but no
significant increase in the glucose level was found. There were no significant
differences in sodium or potassium levels within or between the groups (p > 0.05).

Conclusions: The surgical superiority of RALS technique is known.
However, anesthesia management in this patient group is difficult due to the
risk of the Trendelenburg position and pneumoperitoneum. 

Keywords

robotic surgical procedures, kidney transplantation anesthesia, pneumoperitoneum, head-down tilt

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