Optimal carbon dioxide insufflation pressure during robot-assisted thyroidectomy in patients with various benign and mal
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WORLD JOURNAL OF SURGICAL ONCOLOGY
RESEARCH
Open Access
Optimal carbon dioxide insufflation pressure during robot-assisted thyroidectomy in patients with various benign and malignant thyroid diseases Hoon Yub Kim1†, Yoon Ji Choi2†, Hae-Na Yu3 and Seung Zhoo Yoon3*
Abstract Background: Currently, data are not available concerning a safe insufflation pressure that provides a proper view of the surgical field without adverse metabolic and hemodynamic changes in humans undergoing the robot-assisted thyroidectomy bilateral axillo-breast approach (BABA) using the da Vinci robotic surgical system. The purpose of this study was to determine the optimal carbon dioxide (CO2) insufflation pressure in patients with various benign and malignant thyroid diseases when using the da Vinci robotic surgical system. Methods: A total of 32 patients underwent thyroid surgery at 6 (n = 15), 9 (n = 15), and 12 (n = 2) mmHg. The partial pressure of carbon dioxide (PaCO2), pH, cardiac output, heart rate, and mean arterial pressure were measured at baseline, 30 min and 1, 1.5, and 2 hours after CO2 insufflation, and 30 min after desufflation. Results: CO2 insufflation of 12 mmHg caused severe facial subcutaneous emphysema, hypercarbia, and acidosis during robot-assisted thyroidectomy with BABA. The study was stopped before completion for the patients’ safety in accordance with the study protocol. Applying 6- or 9- mmHg of CO2 insufflation pressure caused increases in PaCO2 and decreases in arterial pH. However, vital signs were stable and pH and PaCO2 were within the physiologic range during the surgery in the 6- and 9-mmHg groups. Conclusions: We propose that a CO2 insufflation pressure under 10 mmHg in robot-assisted thyroidectomy with BABA is the optimal insufflation pressure for patient safety. Keywords: Benign and malignant thyroid diseases, Bilateral axillo-breast approach, Da Vinci, Carbon dioxide insufflation, Pressure, Robot-assisted thyroid surgery
Background Since endoscopic neck surgery was introduced into clinical practice in 1995 by Gagner [1], robot-assisted thyroidectomy via the bilateral axillo-breast approach (BABA) using the da Vinci robotic surgical system has been successfully used for various benign and malignant thyroid diseases with a low rate of adverse effects and excellent cosmetic outcomes [2,3]. BABA is performed by using two circumareolar ports and two axillary ports, which is * Correspondence: [email protected] † Equal contributors 3 Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, South Korea Full list of author information is available at the end of the article
useful for identifying anatomy and dissection during surgery [3,4]. The endo-wrist function of the instrument in the da Vinci robotic surgical system makes it possible to employ complex techniques, even in difficult areas with limited access. During laparoscopic surgery, carbon dioxide (CO2) gas is usually insufflated into the body cavity, and an electronic variable-flow insufflator controls the i
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