For a study, researchers sought to determine if robotic-assisted radical cystectomy (RARC) was linked with more postoperative pulmonary problems than open radical cystectomy (ORC). RARC complicates breathing by requiring posture and abdominal insufflation. Traditional protective mechanical ventilation might be difficult, especially in individuals with obesity or pulmonary diseases. Given the shown advantages of RARC over ORC, the risk of postoperative pulmonary problems warrants additional research.

Adult patients who volunteered to participate in the study and had RARC and ORC for invasive bladder cancer between 2013 and 2018 were identified for a retrospective case analysis. Perioperative and patient factors, as well as postoperative course and outcomes, were studied.

There were 328 individuals who received ORC and 108 patients who underwent RARC. Despite observations of greater peak airway pressures during operation, RARC patients did not have a higher risk of pulmonary problems than ORC patients. Postoperative pulmonary problems were more common in patients with obstructive sleep apnea (OSA) who had ORC. Patients who had RARC required less intraoperative fluid administration, had fewer ICU hospitalizations and had a shorter hospital stay.

Despite the limitations of mechanical ventilation, RARC was not linked with an increase in post-operative pulmonary problems when compared to ORC. It was also observed in patients with a BMI of more than 30 and a diagnosis or strong suspicion of OSA. The data demonstrated that increased pressure ventilation does not enhance the risk of ventilator-induced lung damage in RARC patients, even in normally higher-risk individuals.

Reference: goldjournal.net/article/S0090-4295(21)01159-6/fulltext