Postoperative Pulmonary Complications in Conventional Laparoscopic vs Robot-Assisted Abdominal Surgery.
Longer ventilation duration, not robotic approach, drives pulmonary complication risk
Postoperative Pulmonary Complications in Conventional Laparoscopic vs Robot-Assisted Abdominal Surgery.
IMPORTANCE: Robot-assisted surgery (robot-assisted surgery) is increasingly used for abdominal procedures; however, postoperative pulmonary complications (postoperative pulmonary complications) are more frequent in patients undergoing robot-assisted surgery compared with patients undergoing conventional laparoscopic surgery (conventional laparoscopic surgery).
To compare the incidence of postoperative pulmonary complications after conventional laparoscopic surgery and robot-assisted surgery and to determine which patient-, surgery-, and anesthesia-related factors are associated with postoperative pulmonary complications.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used the Laparoscopic and Robot-Assisted Surgery (Laparoscopic and Robot-Assisted Surgery) database, a pooled dataset containing individual patient data of 2 worldwide prospective cohort studies: the Local Assessment of Ventilatory Management During General Anaesthesia for Surgery (LAS VEGAS) study and the Assessment of Ventilatory Management During General Anesthesia for Robotic Surgery and Its Effects on Postoperative Pulmonary Complications (AVATaR) study.
each extra unit of ventilation time raises pulmonary complication odds by half
Postoperative pulmonary complications occurred in 172 of 903 patients (19.0%) in the robot-assisted surgery group and 174 of 1835 patients (9.5%) in the conventional laparoscopic surgery group (P < .001).
Duration of intraoperative ventilation was longer in robot-assisted surgery compared with conventional laparoscopic surgery (median [IQR] duration, 219 [180-270] vs 95 [68-145] minutes; P < .001) and the intensity of mechanical ventilation was higher (median [IQR] intensity, 84 [69-100] vs 72 [60-87] 4DP + RR; P < .001).
In this cohort study, patients who received robot-assisted surgery vs conventional laparoscopic surgery had a higher incidence of postoperative pulmonary complications and received longer and more intense mechanical ventilation; however, only the duration of ventilation rather than intensity of ventilation or type of surgical approach (ie, robot-assisted surgery vs conventional laparoscopic surgery) was independently associated with the occurrence of postoperative pulmonary complications, indicating that the longer duration of ventilation in robot-assisted surgery underlies the higher incidence of postoperative pulmonary complications observed in those who undergo this type of surgery.