Ultralow Versus Standard Pneumoperitoneum Pressure

Study Overview
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Brief Summary
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The investigators plan to compare insufflation pressures during robotic assisted laparoscopic prostatectomy (RALP). Standard pressure is typically 15 mmHg, while in a previous study the investigators determined that 6 mmHg is possible routinely. Therefore, the investigators plan to compare the clinical outcomes of participants at a pneumoperitoneal pressure of 15 versus 6 mmHg.

Detailed Description
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The investigators to examine the impact of low pressure during robotic assisted laparoscopic prostatectomy (RALP) with the intention of identifying whether lower pressures might benefit participants. The investigators hypothesize that a low insufflation pressure may provide an improvement in postoperative pain and abdominal distension in addition to potential physiologic benefits, and that these factors might then allow a shorter hospital stay. The investigators previously initiated a protocol in September of 2016 (IRB# 1066864) to perform RALPs at an insufflation pressure of 6 mmHg with the intention of increasing the pressure as needed on an individual participant level. In order to determine whether this might allow earlier discharge when successful, the investigators began allowing for same-day discharge in participants meeting appropriate criteria. Having now demonstrated feasibility in over 300 consecutive participants using this ultralow pneumoperitoneum protocol, the investigators now plan to conduct a randomized trial to compare a pressure of 6 mmHg with participants having RALP at a standard pressure of 15 mmHg to determine whether there is a true benefit.

Official Title
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Randomized Study of Ultralow Versus Standard Pneumoperitoneum Pressure During Robotic Prostatectomy Using the AirSeal® Insufflation System

Conditions
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Prostate Cancer

Intervention / Treatment
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* Other: Pneumoperitoneum Pressure 6 mmHg
* Other: Pneumoperitoneum Pressure 15 mmHg


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18 or older Diagnosed with prostate cancer Electing to undergo robotic assisted laparoscopic prostatectomy (RALP) Exclusion Criteria: Age < 18 Emergency surgery Patients with a significant preoperative dependence on narcotic medications Unable to give informed consent Dementia, history of dementia, or other significant mental impairment that would, in the opinion of the investigator, impede patient self-reporting Persons participating in any other research study involving an investigational drug or device or investigational surgical procedure that could interfere with the physiologic parameters being collected (for example, a study evaluating different anesthesia regimens that could confound study results) Non-English-speaking or reading

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Pressure 6 mmHg<br>Pneumoperitoneum Pressure 6 mmHg | Other: Pneumoperitoneum Pressure 6 mmHg<br>* A pneumoperitoneum insufflation pressure of 6 mmHg will be used during robotic assisted laparoscopic prostatectomy (RALP).<br>|
| Active Comparator: Pressure 15 mmHg<br>Pneumoperitoneum Pressure 15 mmHg | Other: Pneumoperitoneum Pressure 15 mmHg<br>* A pneumoperitoneum insufflation pressure of 15 mmHg will be used during robotic assisted laparoscopic prostatectomy (RALP).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative Pain Medication Use | The cumulative dose (milligrams) of each opioid medication administered was calculated and converted to milligram morphine equivalents (MME) for each participant. | Through 1 week postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Post Operative Pain Scores | Each participant was asked to rate their pain on a 0-10 scale, with higher numbers representing worse pain. Patients rated their pain at the following time points: in the post-anesthesia care unit (PACU) upon waking from anesthesia, at hours 4, 12, 16, and 20 after transfer to the floor, and immediately prior to discharge. The pain scores for each patient were averaged. | Through discharge (post-operative day 0 or post-operative day 1) | 
| Operative Ventilation | Average tidal volume (ml) | Intraoperatively | 
| Discharge Day (Post-operative Day 0 or 1) | The day of discharge (post-operative day 0 or post-operative day 1) was recorded for each participant | Through discharge (post-operative day 0 or 1) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Prostatectomy, Robotic, Urology