The following is a summary of “Effects of different positions on lower extremity hemodynamics during robot-assisted laparoscopic radical prostatectomy for prostate cancer,” published in the April 2024 issue of Urology by Wang et al.
This study aimed to investigate the impact of two distinct patient positions on lower extremity hemodynamics during robot-assisted laparoscopic radical prostatectomy (RARP) for prostate cancer.
A cohort of 196 patients who underwent RARP at the institution between February 2020 and March 2022 was included. Among them, 98 patients operated on with the Trendelenburg position and split-leg position with calf reverse arch from March 2021 to March 2022 constituted the observation group, while 98 patients operated on with the Trendelenburg position and low lithotomy position from February 2020 to February 2021 constituted the control group. Utilizing ultrasound diagnostic instruments, researchers measured the internal diameter, mean blood flow velocity, and mean blood flow volume of the left deep femoral vein at various time points: supine position (T0), 5 minutes after positioning in the leg split or low lithotomy position (T1), 5 minutes after pneumoperitoneum (T2), 5 minutes after head-down tilt or head-down tilt and calf reverse arch (T3), 1.5 hours post-surgery initiation (T4), before CO2 gas removal (T5), and before patient exit from the operating room (T6), along with assessing deep venous blood flow patency in both lower extremities pre-operating room exit.
Following pneumoperitoneum establishment, a significant increase in the internal diameter of the deep femoral vein was observed. At the same time, mean blood flow velocity and volume decreased significantly in both groups at T0 (P<0.001). Throughout the surgical duration, the observation group experienced less pronounced effects on lower extremity hemodynamics compared to the control group. From T2 to T6, the observation group exhibited a smaller internal diameter of the femoral vein, alongside increased mean blood flow velocity and volume compared to the control group (P<0.05). Before the departure of the operating room, the observation group demonstrated better deep venous blood flow patency than the control group (P=0.003).
Positioning patients in the Trendelenburg position and split-leg position with calf reverse arch during RARP for prostate cancer yielded a lesser impact on lower extremity hemodynamics compared to the low lithotomy position, potentially mitigating postoperative deep vein thrombosis risk.
Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-024-01462-3
