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

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

References

1. [1] Parmar MS. Chronic renal disease. BMJ 2012;325:85-90.
2. [2] Margreiter R. Renal Medicine: History of Renal Transplantation [Online]. Available: http://www.renalmed.co.uk/history-of/renal-transplant.
3. [3] Erek E, Suleymanlar G, Serdengecti K. Nephrology, dialysis and transplantation in Turkey. Nephrol Dial Transplant 2002;17:2087-93.
4. [4] Modi P, Rizvi J, Pal B, Bharadwaj R, Trivedi P, Trivedi A, et al. Laparoscopic kidney transplantation: an initial experience. Am J Transplant 2011;11:1320-4.
5. [5] Giacomoni A, Di Sandro S, Lauterio A, Concone G, Buscemi V, Rossetti O, et al. Robotic nephrectomy for living donation: surgical technique and literature systematic review. Am J Surg 2016;211:1135-42.
6. [6] Hoznek A, Zaki SK, Samadi DB, Salomon L, Lobontiu A, Lang P, et al. Robotic assisted kidney transplantation: an initial experience. J Urol 2002;167:1604-6.
7. [7] Herling SF, Dreijer B, Wrist Lam G, Thomsen T, Moller AM. Total intravenous anaesthesia versus inhalational anaesthesia for adults undergoing transabdominal robotic assisted laparoscopic surgery. Cochrane Database Syst. Rev 2017;4:CD011387.
8. [8] Hammer Ø, Harper DAT, Ryan PD. PAST: Paleontological Statistics Software Package for Education and Data Analysis. Palaeontol Electron 2001;4:1-9.

9. [9] Meininger D, Westphal K, Bremerich DH, Runkel H, Probst M, Zwissler B, et al. Effects of posture and prolonged pneumoperitoneum on hemodynamic parameters during laparoscopy. World J Surg 2008;32:1400-5.
10. [10] Kalmar AF, Foubert L, Hendrickx JFA, Mottrie A, Absalom A, Mortier EP, et al. Influence of steep Trendelenburg position and CO(2) pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy. Br J Anaesth 2010;104:433-9.
11. [11] Rosendal C, Markin S, Hien MD, Motsch J, Roggenbach J. Cardiac and hemodynamic consequences during capnoperitoneum and steep Trendelenburg positioning: lessons learned from robot-assisted laparoscopic prostatectomy. J Clin Anesth 2014;26:383-9.
12. [12] O’Brien TJ, Ebert TJ. Physiologic changes associated with the supine position. In Martin JT, Warner MA (ed.): Positioning in Anesthesia and Surgery, 3rd ed. Philadelphia: WB Saunders. 1997.
13. [13] Pandey R, Garg R, Roy K, Darlong V, Punj J, Kumar A. Perianesthetic management of the first robotic partial cystectomy in bladder pheochromocytoma. A case report. Minerva Anestesiol 2010;76;294-7.
14. [14] Horgan S, Vanuno D, Sileri P, Cicalese L, Benedetti E. Robotic-assisted laparoscopic donor nephrectomy for kidney transplantation. Transplantation 2002;73:1474-9.
15. [15] Fracalanza S, Ficarra V, Cavalleri S, Galfano A, Novara G, Mangano A, et al. Is robotically assisted laparoscopic radical prostatectomy less invasive than retropubic radical prostatectomy? Results from a prospective, unrandomized, comparative study. BJU Int 2008;101:1145-9.
16. [16] Phong SVN, Koh LKD. Anaesthesia for robotic-assisted radical prostatectomy: considerations for laparoscopy in the Trendelenburg position. Anaesth Intensive Care 2007;35:281-5.
17. [17] Danic MJ, Chow M, Alexander G, Bhandari A, Menon M, Brown M. Anesthesia considerations for robotic-assisted laparoscopic prostatectomy: a review of 1,500 cases. J Robot Surg 2007;1:119-23.
18. [18] Rebholz CM, Coresh J, Grams ME, Steffen LM, Anderson CAM, Appel LJ, et al. Dietary acid load and incident chronic kidney disease: Results from the ARIC Study. Am J Nephrol 2015;42:427-35.
19. [19] Murray CJL, Richards MA, Newton JN, Fenton KA, Anderson HR, Atkinson C, et al. UK health performance: findings of the Global Burden of Disease Study 2010. Lancet 2013;381:997-1020.
20. [20] Lentine KL, Kasiske BL, Levey AS, Adams PL, Alberú J, Bakr MA, et al. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation 2017;101(8 Suppl 1);S7-S105.
21. [21] Streja E, Nicholas SB, Norris KC. Controversies in timing of dialysis initiation and the role of race and demographics. Semin Dial 2013;26:658-66.
22. [22] Hsu RL, Kaye AD, Urman RD. Anesthetic challenges in robotic-assisted urologic surgery. Rev Urol 2013;15:178-84.
23. [23] Lee JR. Anesthetic considerations for robotic surgery. Korean J Anesthesiol 2014;66:3-11.
24. [24] Breda A, Territo A, Gausa L, Decaestecker K, Stöckle M, Fornara P, et al. Robotic kidney transplantation: European one-year data. Eur Urol 2018;16 Suppl;e1977-8.