Hemodynamic Monitoring-Guided Goal-Directed Fluid Therapy in Robotic Radical Prostatectomy

Effectiveness of Goal-Directed Fluid Therapy Guided by Minimally Invasive Hemodynamic Monitoring in Robotic Radical Prostatectomy: A Prospective Observational Study

This prospective observational cohort study evaluated goal-directed fluid therapy guided by minimally invasive hemodynamic monitoring in adult male patients undergoing elective robotic radical prostatectomy. Patients were prospectively enrolled and followed according to the intraoperative fluid management strategy used in routine clinical practice.

Patients managed with LiDCO®Rapid-guided goal-directed fluid therapy constituted the hemodynamic monitoring-guided group, while patients managed with conventional intraoperative fluid therapy constituted the control group. No randomization or additional research-related intervention was performed.

The study compared the two fluid management strategies with respect to intraoperative crystalloid fluid administration and selected perioperative clinical and laboratory parameters.

This prospective observational cohort study was conducted in adult male patients undergoing elective robotic radical prostatectomy. The study compared two intraoperative fluid management strategies used in routine clinical practice: conventional fluid therapy and goal-directed fluid therapy guided by minimally invasive hemodynamic monitoring.

In the goal-directed fluid therapy group, intraoperative fluid management was guided by the LiDCO®Rapid hemodynamic monitoring system. A baseline crystalloid infusion of 2 mL/kg/hour was administered. Additional fluid boluses were given according to hemodynamic assessment, particularly when stroke volume variation (SVV) exceeded 15%. Hemodynamic parameters monitored included stroke volume variation, stroke volume, pulse pressure variation, systemic vascular resistance, and cardiac index.

In the conventional fluid therapy group, patients received crystalloid fluid at approximately 4 mL/kg/hour. Additional fluid administration was determined by the attending anesthesiologist according to routine clinical assessment and standard intraoperative monitoring.

All patients underwent standard anesthetic management and routine invasive arterial blood pressure monitoring. Assignment to the fluid management strategy was not randomized and reflected the clinical management approach used during surgery. No additional therapeutic intervention was performed solely for research purposes. Perioperative clinical, hemodynamic, laboratory, and fluid balance data were prospectively recorded for comparison between the two groups.

Inclusion Criteria:

• Male patients aged 18 to 80 years
• Patients scheduled for elective robotic radical prostatectomy
• American Society of Anesthesiologists physical status I-III
• Patients who provide written informed consent

Exclusion Criteria:

• Refusal to participate in the study
• Cardiac rhythm disturbances
• Severe left ventricular dysfunction, defined as ejection fraction <40%
• Severe valvular heart disease or active heart failure
• Chronic renal failure, dialysis dependency, or preoperative creatinine >2 mg/dL
• Hemoglobin <8 g/dL
• Pre-existing hematological conditions requiring planned blood transfusion
• Body mass index >40 kg/m²
• Major peripheral vascular disease
• Implanted pacemaker or implantable cardioverter-defibrillator
• Chronic obstructive pulmonary disease
• Conditions associated with increased intra-abdominal pressure
• Emergency surgery