The online version of this article (doi:10.1186/1477-7819-10-202) contains supplementary material, which is available to authorized users.
Hoon Yub Kim, Yoon Ji Choi contributed equally to this work.
The authors declare that they have no competing interests.
HYK helped conduct the study and write the manuscript, YJC helped analyze the data and write the manuscript, HNY writed the manuscript and SZY helped design the study, conduct the study, analyze the data, and write the manuscript. All authors read and approved the final manuscript.
Currently, data are not available concerning a safe insufflation pressure that provides a proper view of the surgical field without adverse metabolic and hemodynamic changes in humans undergoing the robot-assisted thyroidectomy bilateral axillo-breast approach (BABA) using the da Vinci robotic surgical system. The purpose of this study was to determine the optimal carbon dioxide (CO2) insufflation pressure in patients with various benign and malignant thyroid diseases when using the da Vinci robotic surgical system.
A total of 32 patients underwent thyroid surgery at 6 (n = 15), 9 (n = 15), and 12 (n = 2) mmHg. The partial pressure of carbon dioxide (PaCO2), pH, cardiac output, heart rate, and mean arterial pressure were measured at baseline, 30 min and 1, 1.5, and 2 hours after CO2 insufflation, and 30 min after desufflation.
CO2 insufflation of 12 mmHg caused severe facial subcutaneous emphysema, hypercarbia, and acidosis during robot-assisted thyroidectomy with BABA. The study was stopped before completion for the patients’ safety in accordance with the study protocol. Applying 6- or 9- mmHg of CO2 insufflation pressure caused increases in PaCO2 and decreases in arterial pH. However, vital signs were stable and pH and PaCO2 were within the physiologic range during the surgery in the 6- and 9-mmHg groups.
We propose that a CO2 insufflation pressure under 10 mmHg in robot-assisted thyroidectomy with BABA is the optimal insufflation pressure for patient safety.
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Lee KE, Koo Do H, Kim SJ, Lee J, Park KS, Oh SK, Youn YK: Outcomes of 109 patients with papillary thyroid carcinoma who underwent robotic total thyroidectomy with central node dissection via the bilateral axillo-breast approach. Surgery. 2010, 148: 1207-1213. 10.1016/j.surg.2010.09.018. CrossRefPubMed
Bready LL: Anesthesia for laparoscopic surgery. Curr Rev Clin Anesth. 1995, 15: 133-144.
Holzman M, Sharp K, Richards W: Hypercarbia during carbon dioxide gas insufflation for therapeutic laparoscopy: a note of caution. Surg Laparosc Endosc. 1992, 2: 11-14. PubMed
Gottlieb A, Sprung J, Zheng XM, Gagner M: Massive subcutaneous emphysema and severe hypercarbia in a patient during endoscopic transcervical parathyroidectomy using carbon dioxide insufflation. Anesth Analg. 1997, 84: 1154-1156. PubMed
Worrell JB, Cleary DT: Massive subcutaneous emphysema and hypercarbia: complications of carbon dioxide absorption during extraperitoneal and intraperitoneal laparoscopic surgery–case studies. AANA J. 2002, 70: 456-461. PubMed
Liem MS, Kallewaard JW, de Smet AM, van Vroonhoven TJ: Does hypercarbia develop faster during laparoscopic herniorrhaphy than during laparoscopic cholecystectomy? Assessment with continuous blood gas monitoring. Anesth Analg. 1995, 81: 1243-1249. PubMed
Joris JL: Anesthetic management of laparoscopy. Anesthesia. Edited by: Miller RD. 1994, New York: Churchill-Livingstone, 2011-2029.
Huang SJ, Lee CY, Yeh FC, Chang CL: Hypercarbia is not the determinant factor of systemic arterial hypertension during carboperitoneum in laparoscopy. Ma Tsui Hsueh Tsa Chi. 1991, 29: 592-595. PubMed
Rademaker BM, Bannenberg JJ, Kalkman JC, Meyer DW: Effect of pneumoperitoneum with helium on hemodynamics and oxygen transport: a comparison with carbon dioxide. J Laparosc Surg Endosc. 1995, 5: 15-20. CrossRef
Sandham JD, Hull RD, Brant RF, Knox L, Pineo GF, Doig CJ, Laporta DP, Viner S, Passerini L, Devitt H, Kirby A, Jacka M, Canadian Critical Care Clinical Trials Group: A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med. 2003, 348: 5-14. 10.1056/NEJMoa021108. CrossRefPubMed
Harvey S, Harrison DA, Singer M, Ashcroft J, Jones CM, Elbourne D, Brampton W, Williams D, Young D, Rowan K: Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial. Lancet. 2005, 366: 472-477. 10.1016/S0140-6736(05)67061-4. CrossRefPubMed
Godje O, Hoke K, Goetz AE, Felbinger TW, Reuter DA, Reichart B, Friedl R, Hannekum A, Pfeiffer UJ: Reliability of a new algorithm for continuous cardiac output determination by pulse-contour analysis during hemodynamic instability. Crit Care Med. 2002, 30: 52-58. 10.1097/00003246-200201000-00008. CrossRefPubMed
Biancofiore G, Critchley LA, Lee A, Bindi L, Bisa M, Esposito M, Meacci L, Mozzo R, DeSimone P, Urbani L, Filipponi F: Evaluation of an uncalibrated arterial pulse contour cardiac output monitoring system in cirrhotic patients undergoing liver surgery. Br J Anaesth. 2009, 102: 47-54. 10.1093/bja/aen343. CrossRefPubMed
- Optimal carbon dioxide insufflation pressure during robot-assisted thyroidectomy in patients with various benign and malignant thyroid diseases
Hoon Yub Kim
Yoon Ji Choi
Seung Zhoo Yoon
- BioMed Central
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