Retrospective evaluation of robotic prostatectomy cases performed in Hacettepe University operating theaters between 2018-2021 in terms of anesthesia management and perioperative complications

Robot-assisted laparoscopic radical prostatectomy (RALRP) has recently been introduced as a major innovation in the urology field. The fact that it has advantages such as being minimally invasive, less postoperative pain, and less bleeding, also brings us disadvantages such as longer operative times, requirement of steep Trendelenburg position, and hypercapnia related to pneumoperitoneum. Studies on perioperative complications of RALRP operations have recently been getting adopted. In this study, we aimed to analyze the management and perioperative complications of RALRP procedures that were done at Hacettepe University Urology operating theatres between the years 2018 and 2021. After the IRB approval is taken, data related to the RALRP surgeries between March/2018 and June/2021 were gathered through anesthesia reports on patient charts and Hacettepe University Electronic Medical Records retrospectively. The data was screened for patient demographics, anesthesia management, and perioperative complications. 86 patients were included in the study and the mean age was 63,07 +/-8,02 years (44-80), mean body weight was 81,38+/-11,64 kg (55-120) and mean BMI was 27.15+/-3,54kg/m2(19,03-37,45). 64(%74) patients had a BMI over 25 kg/m2 and were obese. The mean hospital length of stay was 3,09+/-1,04 days(2-8). The mean operative time was 218+/-34,6 minutes (155-320) and the mean anesthesia time was 274,78+/-36,04 minutes (210-385). Mean hemoglobin decrease was 0,99+/-0,81g/dl(-0,90-3,40). Operative time was found to decrease from 230 minutes in 2020 to 200 minutes in 2021. On the other hand, operative time was found to increase along with increasing BMI in a statistically significant way. In addition, hypercarbia was found to be more frequent among obese patients. 32(%34) patients had hypotension and 6(%7) patients had hypercarbia intraoperatively. No patients had hypoxia or needed red blood cell (RBC) transfusion intraoperatively. 2(2%) patients needed RBC transfusion, and 1(1%) patient needed fresh frozen plasma transfusion at postoperative period. 1 (1%) patient had a pulmonary embolus, 1 (1%) patient developed peripheral neuropathy, and (1%) patient had ileus postoperatively. RALRP constitutes an important alternative to open radical retropubic prostatectomy but the anesthesia risks it brings along with the advanteges must be taken into account as well. Prolongation of the procedure and CO2 retention and other possible complications should be well considered, particularly in obese patients.