Optimal carbon dioxide insufflation pressure during robot-assisted thyroidectomy in patients with various benign and malignant thyroid diseases

• Main Authors: Kim Hoon, Choi Yoon, Yu Hae-Na, Yoon Seung
• Format: Article
• Language: English
• Published: BMC 2012-09-01
• Series: World Journal of Surgical Oncology
• Subjects: Benign and malignant thyroid diseases; Bilateral axillo-breast approach; Da Vinci; Carbon dioxide insufflation; Pressure; Robot-assisted thyroid surgery
• Online Access: http://www.wjso.com/content/10/1/202

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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.</p> <p>Conclusions</p> <p>We propose that a CO₂ insufflation pressure under 10 mmHg in robot-assisted thyroidectomy with BABA is the optimal insufflation pressure for patient safety.</p>