Is the Use of Ultra-low Insufflation Pressure Safe and Feasible in Robot Assisted Radical Prostatectomy

Objective: Current innovations in minimally invasive surgery include using ultra-low insufflation pressure with the aim of improving peri-operative and short-term clinical outcomes. Despite an exponential increase in the use of robotic technology, there remains limited literature supporting the use of ultra-low pressure during robotic surgery. We performed a feasibility study of ultra-low-pressure robot-assisted laparoscopic radical prostatectomy (RARP).

Material And Methods: Prospective data related to standard pressure (15 mm Hg) RARP (Group 1) and ultra-low-pressure (6 mm Hg) RARP (Group 2) were collected and compared to assess the peri-operative and short-term outcomes.

Results: Outcome data of 112 consecutive patients (56 in each group) were collected. Mean age, pre-operative prostate specific antigen, body mass index, and performance status were similar in both groups. Mean console time was shorter in ultra-low-pressure RARP group (125 minutes) than in standard pressure RARP group (138 minutes) (p=0.016). Furthermore, there was no significant difference in console time or estimated blood loss between these 2 groups for patients with RARP and lymph node dissection. No patients from either group required conversion to an open procedure or received a peri-operative blood transfusion. None of the patients in either group developed post-operative complications or needed readmission.

Conclusion: Our study has demonstrated that ultra-low-pressure RARP is a practical and safe option, and it supports the routine practice of ultra-low-pressure RARP with slow adaptation in other complex robotic surgeries, such as robotic cystectomy for bladder cancer.