The Risk Factors of Postoperative Respiratory Insufficiency after Prolonged Robotic Radical Prostatectomy

Background: Robotic radical prostatectomy is performed in elderly patients and requires extreme changes in the patient’s position and is often associated with a long surgery time. This study reviewed the pulmonary complications occurring after a robotic radical prostatectomy and analyzed the potential risk factors. Methods: The medical records of all patients who had undergone robotic radical prostatectomy at our institution were reviewed. Among the 80 total patients, 58 were capable of spontaneous respiration at the end of surgery (Group I), whereas 22 patients required assisted ventilation (Group II). A comparison between the two groups was made in terms of the demographic characteristics, coexisting diseases, anesthesia and operation time, amount of intraoperative blood loss and transfused blood products. Results: The mean age of the patients was 67.2 ± 7.3 years. The mean operation time was 384.1 ± 203.4 min (range, 195−1,180 min). The anesthesia and operation time, amount of intraoperative blood loss and number of transfused patients were all significantly higher in Group II. Univariate analysis revealed age, body mass index, intraoperative blood loss and transfusion, anesthesia and operation time to be related to postoperative respiratory insufficiency. Multivariate analysis revealed intraoperative transfusion and operation time to be predictive risk factors. Conclusions: Prolonged laparoscopic surgery in a steep Trendelenburg position has a high likelihood of postoperative respiratory insufficiency, with the intraoperative transfusion and a longer operation time being possible contributing factors.