UNC COMPUTER & ROBOTIC ENHANCED SURGERY CENTER
Robotic Assisted Para-aortic Node Dissection
Step by step approach
JOHN F. BOGGESS, MD
Associate Professor
0
UNC COMPUTER & ROBOTIC ENHANCED SURGERY CENTER
1
UNC COMPUTER & ROBOTIC ENHANCED SURGERY CENTER
2
UNC COMPUTER & ROBOTIC ENHANCED SURGERY CENTER
Port Placement
3
UNC COMPUTER & ROBOTIC ENHANCED SURGERY CENTER
Bowel Retraction
4
UNC COMPUTER & ROBOTIC ENHANCED SURGERY CENTER
Right Ureter and Colon Mesentary
5
UNC COMPUTER & ROBOTIC ENHANCED SURGERY CENTER
Duodenum
6
UNC COMPUTER & ROBOTIC ENHANCED SURGERY CENTER
Distal Pedicle
7
UNC COMPUTER & ROBOTIC ENHANCED SURGERY CENTER
Dissection up Aorta
8
UNC COMPUTER & ROBOTIC ENHANCED SURGERY CENTER
Proximal Pedical
9
UNC COMPUTER & ROBOTIC ENHANCED SURGERY CENTER
Left Nodal Dissection
10
UNC COMPUTER & ROBOTIC ENHANCED SURGERY CENTER
Ventilation
Obesity
Excess fat decreases chest wall and lung
compliance
  O2 consumption,  CO2 production
Pneumoperitoneum
Increase intra-abdominal pressure
Decrease thoraco-pulmonary compliance
Increase PaCO2
11
UNC COMPUTER & ROBOTIC ENHANCED SURGERY CENTER
Ventilation
Jan 1, 2007 – Sept 1, 2007
Endometrial ca pts, n = 26
13 BMI < 30
13 BMI > 30
Pressure-control ventilation in ALL patients
during operative time…
12
800
700
600
500
400
Tidal Volumes
300
200
100
51
.5
45
39
.2
37
36
34
.4
30
.3
28
.2
27
.8
27
.5
25
23
.6
0
20
.4
mL
UNC COMPUTER & ROBOTIC ENHANCED SURGERY CENTER
Tidal Volumes
BMI
13
60
50
40
peak airway pressure
ET C O2
30
20
10
51
.5
45
39
.2
37
36
34
.4
30
.3
28
.2
27
.8
27
.5
25
23
.6
0
20
.4
mm Hg
UNC COMPUTER & ROBOTIC ENHANCED SURGERY CENTER
Peak airway pressure
BMI (kg/m2)
14
UNC COMPUTER & ROBOTIC ENHANCED SURGERY CENTER
Choosing vent mode
Volume-control
Square waveform
pattern
Control minute
ventilation
Pressure-control
Decelerating flow
pattern
Higher volume for
same PIP
15
UNC COMPUTER & ROBOTIC ENHANCED SURGERY CENTER
Volume- control ventilation
16
UNC COMPUTER & ROBOTIC ENHANCED SURGERY CENTER
Pressure-control ventilation
17
UNC COMPUTER & ROBOTIC ENHANCED SURGERY CENTER
Questions?
18