Cerebral oedema following robotic surgery: a rare complication

Abstract

The mechanics of robotic assistance may be used to reduce these risks by significantly reducing intra-abdominal pressure improving venous return. The use of robotics in surgery has been increasing over the last 10 years, and the benefits have been well documented. We present an unusual complication following robotic assisted radical hysterectomy performed for cervical cancer.

Can optic nerve sheath diameter assess increased intracranial pressure in pneumoperitoneum and trendelenburg position?

“…Because of persistent agitation, a brain CT was performed where cerebral edema was discovered. [20] Another example of how prolonged surgery in a head-down position may lead to cerebral edema was reported with two patients who underwent robotic radical cystectomy and experienced neurological deterioration after extubation. The researcher had interesting recommendations about this kind of procedure they suggest adjusting duration and positioning during prolonged surgery in a steep head-down position.…”

Complications of robotic-assisted laparoscopic surgery distant from the surgical site

“…9-11 15 23 28 63 102 The incidence of head and neck oedema was reported to be 12.5%. 63 Such oedema was severe enough to delay extubation until postoperative day two in one case, 28 and has been reported to be severe enough to necessitate reintubation in 0.7% of cases. 6 Chemosis and conjunctival oedema are considered common effects of prolonged steep Trendelenburg, with no demonstrated clinical consequence and had an incidence of 33-43.8%.…”

“…Cerebral oedema [27][28][29][30] Not listed Steep Trendelenburg [31][32][33][34] Limit time in steep Trendelenburg 28 Prolonged operative time 28 Restrict steep Trendelenburg to 30 degrees maximum 28 Prolonged Steep Trendelenburg 28 Fluid restriction 28 CO2 peritoneum of 16 mm Hg 28 Limit operative time 28 Limit intra-abdominal insufflation pressure to 8 mm Hg 28 application of shoulder restraints, which depress the acromioclavicular joint and clavicle relative to the torso and increase the angle of abduction to > 90 degrees. After discontinuing the use of beanbags and adducting both arms, the authors' institution had no further brachial plexopathies across 2,674 cases.…”

“…Cerebral oedema occurred in three cases (case report and case series) in patients who underwent RAS, 27 28 and described as a concern in robotic cases that could lead to postoperative agitation in four papers total. [27][28][29][30] The cases reported varied from depressed mental status necessitating reintubation in the postanaesthesia care unit, with CT scan findings consistent with cerebral oedema to delayed extubation with a normal CT. 27 28 The two cases with confirmed radiologic evidence of cerebral oedema underwent treatment with dexamethasone and diuretics with ultimate resolution of symptomatology. 27 The aetiology is thought to be secondary to an increase in central venous pressure from the combination of Trendelenburg position and pneumoperitoneum with resultant increase in intracranial pressure and capillary leak.…”

“…[31][32][33][34] Preventative strategies suggested included limiting time in steep Trendelenburg, fluid restriction, limiting intra-abdominal insufflation pressure to 8 mm Hg, and limiting operative time when possible. 28…”