New technologies and applications of laparoscopic and robotic surgery in urology

Background: cool and dry gas insufflation during laparoscopy induces hypothermia and cytokine increase, with significant perioperative morbidity. Few studies have suggested that warmed and humidified insufflation leads to an improved body core temperature (BCT) maintenance, a reduction of the inflammatory response and an improved quality of postoperative course, compared with standard insufflation. Objective: to assess if warmed and humidified CO2 insufflation with HumiGard™ device can achieve significant benefits over standard insufflation in terms of risk of hypothermia and cytokine response, in the setting of robot-assisted radical prostatectomy (RARP). Design: prospective, randomized, controlled clinical trial (September, 2015, June, 2016). Setting: single center study in a tertiary hospital. Participants: 64 patients with prostate cancer undergoing RARP were randomized, 32 to the treatment group and 32 to the control group. Intervention: the treatment group (H+WB) received warmed, humidified CO2 insufflation with HumiGard™ device, plus hot air warming blanket; the control group (WB) received standard CO2 insufflation, plus hot air warming blanket. Main outcomes and measures: BCT, plasma levels of cytokines IL-6 and TNF-α, pain scores, and intraoperative parameters. The data were analyzed according to the Bayesian paradigm. Results: intraoperative BCT increased in both groups during surgery, with a statistically significant difference favoring group H+WB, ending at 0.2°C higher on average than group WB. The overall BCT increase was 0.088 degree per hour in the WB group, with an additional 0.064 degree per hour in the H+WB group. No difference across groups, at none of the time points, could be shown as far as mean serum cytokine levels was concerned. No statistical differences were noted for pain scores and the other intraoperative parameters. Conclusions: during RARP, warm and humidified CO2 insufflation with the HumiGard™ device was more effective than the standard CO2 insufflation in maintaining the patient’s heat homeostasis, even if the difference was minimal. No benefit could be shown in terms of cytokine levels and pain scores. Trial registration: Clinicaltrials.gov Identifier: NCT02586974