Plis M. O., Tsarev A. V.

CHANGES IN HEMODYNAMIC PARAMETERS DURING ROBOT-ASSISTED SURGICAL PROCEDURES DEPENDING ON THE TYPE OF ANESTHESIA

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About the author:

Plis M. O., Tsarev A. V.

Heading:

CLINICAL AND EXPERIMENTAL MEDICINE

Type of article:

Scientific article

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Robot-assisted surgical interventions are widely used in modern surgery; however, the creation of pneumoperito neum and the use of the steep Trendelenburg position lead to pronounced and multidirectional changes in systemic hemodynamics, which increases the risk of intraoperative hypotension and organ hypoperfusion. The aim of the study was to perform a comparative assessment of changes in systemic hemodynamics during robot-assisted surgical interventions depending on the type of anesthetic management. The study included 81 patients who underwent elective surgery using the da Vinci system in 2022–2024. The patients were divided into two groups: inhalational anesthesia with sevoflurane (n=45) and total intravenous anesthesia with propofol (n=36). The parameters of systolic, diastolic, and mean arterial pressure, as well as heart rate, were assessed at five stages of the surgical procedure. It was established that the baseline hemodynamic parameters in both groups were comparable (p>0.05). Intraoperatively, significantly higher values of arterial pressure and heart rate were recorded in the inhalational anesthesia group compared with the total intravenous anesthesia group (p<0.05–0.01). The most pronounced inter group differences were observed at the stage of hemostasis. The obtained results indicate that the choice of anesthetic technique significantly affects the nature of the intra operative hemodynamic response. Inhalational anesthesia is associated with a more stable hemodynamic profile, which may have clinical significance for the prevention of intraoperative hypotension, particularly in elderly patients and those with concomitant pathology.

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Bibliography:

1. Makary J, van Diepen DC, Arianayagam R, McClintock G, Fallot J, Leslie S, et al. The evolution of image guidance in robotic-assisted laparoscopic prostatectomy (RALP): a glimpse into the future. J Robot Surg. 2022;16(4):765-774. DOI: 10.1007/s11701-021-01305-5.
2. Ilic D, Evans SM, Allan CA, Jung JH, Murphy D, Frydenberg M. Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer. Cochrane Database Syst Rev. 2017;9(9):CD009625. DOI: 10.1002/14651858.CD009625.pub2.
3. Chiumello D, Fratti I, Coppola S. The intraoperative management of robotic-assisted laparoscopic prostatectomy. Curr Opin Anaesthesiol. 2023;36(6):657-665. DOI: 10.1097/ACO.0000000000001309.
4. Cotoia A, Discenza A, Rauseo M, Matella M, Caggianelli G, Ciaramelletti R, et al. Intraoperative hypotension during robotic-assisted radical prostatectomy: A randomised controlled trial comparing standard goal-directed fluid therapy with hypotension prediction index-guided goal directed fluid therapy. Eur J Anaesthesiol. 2025;42(10):916-923. DOI: 10.1097/EJA.0000000000002211.
5. Aceto P, Galletta C, Cambise C, Punzo G, Luca E, Schipa C, et al. Challenges for anaesthesia for robotic-assisted surgery in the elderly: A narrative review. Eur J Anaesthesiol Intensive Care. 2023;2(2):e0019. DOI: 10.1097/EA9. 0000000000000019.
6. Chung YH, Jeong YS, Martin GL, Choi MS, Kang YJ, Lee M, et al. Prediction of blood pressure changes associated with abdominal pressure changes during robotic laparoscopic low abdominal surgery using deep learning. PLoS One. 2022;17(6):e0269468. DOI: 10.1371/journal.pone.0269468.
7. Ono N, Nakahira J, Nakano S, Sawai T, Minami T. Changes in cardiac function and hemodynamics during robot-assisted laparoscopic prostatectomy with steep head-down tilt: a prospective observational study. BMC Res Notes. 2017;10(1):341. DOI: 10.1186/s13104-017 2672-z.
8. Pawlik MT, Prasser C, Zeman F, Harth M, Burger M, Denzinger S, et al. Pronounced haemodynamic changes during and after robotic-assisted laparoscopic prostatectomy: a prospective observational study. BMJ Open. 2020;10(10):e038045. DOI: 10.1136/bmjopen-2020-038045.
9. Kılınç E, Yildirim SA, Ulugöl H, Büyüköner EE, Güçyetmez B, Toraman F. The evaluation of cardiac functions in deep Trendelenburg position during robotic-assisted laparoscopic prostatectomy. Front Med (Lausanne). 2023;10:1273180. DOI: 10.3389/fmed.2023.1273180.
10. Sakai Y, Yasuo M T, Oyama T, Murakami C, Kakuta N, Tanaka K. Noninvasive continuous blood pressure monitoring by the ClearSight system during robot-assisted laparoscopic radical prostatectomy. J Med Invest. 2018;65(1.2):69-73. DOI: 10.2152/jmi.65.69.
11. Mascha EJ, Yang D, Weiss S, Sessler DI. Intraoperative Mean Arterial Pressure Variability and 30-day Mortality in Patients Having Noncardiac Surgery. Anesthesiology. 2015;123(1):79-91. DOI: 10.1097/ALN.0000000000000686.
12. Kim TL, Kim N, Shin HJ, Cho MR, Park HR, Kim SY. Intraoperative mean arterial pressure and acute kidney injury after robot-assisted laparoscopic prostatectomy: a retrospective study. Sci Rep. 2023;13(1):3318. DOI: 10.1038/s41598-023-30506-1.
13. Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, et al. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology. 2013;119(3):507-515. DOI: 10.1097/ALN.0b013 e3182a10e26.
14. Hernandez-Meza G, Gainsburg DM. Anesthetic concerns for robotic-assisted laparoscopic radical prostatectomy: an update. Minerva Anestesiol. 2023;89(9):812-823. DOI: 10.23736/S0375-9393.23.17284-1.
15. Aceto P, Galletta C, Cambise C, Punzo G, Luca E, Schipa C, et al. Challenges for anaesthesia for robotic-assisted surgery in the elderly: A narrative review. Eur J Anaesthesiol Intensive Care. 2023;2(2):e0019. DOI: 10.1097/EA9.0000000000000019.

Publication of the article:

«Bulletin of problems biology and medicine», 2026 Issue 1, 180, 327-335 pages, index UDC 616-089.8:004.896]-089.5-085.211-07:612.13

DOI:

10.29254/2077-4214-2026-1-180-327-335