Consol Time and Acute Kidney Injury in Robotic-assisted Prostatectomy
Condition: Acute Kidney Injury; Hemodynamic Instability
MeSH terms: Acute Kidney Injury; Wounds and Injuries
Study type: Observational

Summary: 
      Robotic-assisted laparoscopic prostatectomy (RALP) is the gold standard surgical technique in
      prostate surgery. Many Robotic-laparoscopic surgical techniques also require the
      intraoperative deep Trendelenburg position and intravenous fluid restriction during surgery.
      However, the possible side effects of the deep Trendelenburg's position and the fluid
      restriction on the cardiovascular and renal systems during surgery are unknown. Although the
      Trendelenburg position is a life-saving maneuver in hypovolemic patients, it also carries
      undesirable risks. Long console time may contribute to the development of acute kidney injury
      (AKI) by prolonging the Trendelenburg time and the fluid-restricted time. In this study,
      investigators aimed to demonstrate the effect of console time on the development of AKI.
      Investigators also aimed to determine the hemodynamic risk factors that cause the development
      of AKI in patients monitored with the pressure Recording Analytical Method (PRAM).
    

Detailed description: 
      Although open surgery has been used for a long time in the treatment of prostate diseases,
      robotic-assisted laparoscopic prostatectomy (RALP) has become more common in the last 20
      years. The excellence in results has made the use of the robot the gold standard in prostate
      surgery. However, the presence of two critical factors during RALP surgery still bothers
      clinicians. The first of these is severe fluid restriction and the other is the deep
      Trendelenburg position and pneumoperitoneum. The prolongation of the robotic console time
      also causes the prolongation of fluid restriction and Trendelenburg time. This combination
      may cause significant pathophysiological changes in both the renal and cardiac systems and
      may lead to postoperative acute renal injury (AKI). AKI is a serious clinical complication
      with increasing incidence and is associated with adverse short-term and long-term outcomes
      worldwide, resulting in a large healthcare burden. Intraoperative advanced monitoring
      techniques can contribute to the prevention of renal damage that may occur by providing early
      recognition of these pathophysiological changes occurring in the renal and cardiac systems.

      The aim of our study was to determine the effect of console duration on the incidence of AKI
      after RALP which was managed using intraoperative advanced monitoring techniques (pressure
      recording analytical method-PRAM). In addition, this study aimed to evaluate the ability of
      changes in hemodynamic parameters to predict the development of AKI in RALP patients who
      underwent restrictive fluid therapy.
    

Intervention name(s): Restrictive fluid therapy
Intervention type(s): Other
Intervention description(s): 0,5 ml/hour fluid administration during prostatic anastomosis.
After general anesthesia induction, the patients were placed in the deep Trendelenburg position (at least 25°-45° upside down).
Other intervention name(s): Trendelenburg position.
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The patients with ASA (American Society Of Anesthesiology) physical status 1-3 who
        underwent RALP with restrictive fluid therapy during console period
      
Keywords: Robotic-assisted laparoscopic prostatectomy; Acute kidney injury; Restrictive fluid therapy; Pressure recording analytical method