Experimental Study of Cardiorespiratory and Stress Factors in Esophageal Surgery Using Robot-Assisted Thoracoscopic or Open Thoracic Approach

摘要

BACKGROUND: Our aim was to compare cardiovascular and stress response to robotic technology during thoracoscopic mobilization and anastomosis of the esophagus vs the conventional open approach. DESIGN: Randomized experimental study. SETTING: Department of Experimental Surgery, University of Heidelberg. SUBJECTS: Twelve pigs randomized to undergo robotic or conventional surgery (6 animals each). INTERVENTIONS: Fundus rotation gastroplasty followed by esophageal mobilization and intrathoracic anastomosis by conventional or robotic surgery. MAIN OUTCOME MEASURES: Mean arterial pressure, central venous pressure, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, cardiac output, pulmonary vascular resistance, partial oxygen pressure, alveolar-arterial difference in partial pressure of oxygen, and arteriovenous oxygen content difference measured preoperatively, during esophageal manipulation, and 30 minutes after operation. Operative stress was assessed by plasma levels of cortisol and substance P. RESULTS: Hemodynamic measures showed higher intraoperative central venous pressure and pulmonary vascular resistance in the open surgery group, whereas cardiac output was significantly decreased compared with the robotic group. Blood gas values showed significant deterioration during esophageal manipulation with open surgery in contrast to the robotic group. Substance P and cortisol levels were significantly higher with the open approach. CONCLUSIONS: The robot-assisted approach is associated with improved intraoperative cardiopulmonary function and seems to be a less stressful technique.