Does steep Trendelenburg positioning effect the ocular hemodynamics and intraocular pressure in patients undergoing robotic cystectomy and robotic prostatectomy?

Ozcan, Muhammet Fuat; Akbulut, Ziya; Gürdal, Canan; Tan, Sinan; Yildiz, Yelda; Bayraktar, Serdar; Ozcan, Ayse Nur; Ener, Kemal; Altinova, Serkan; Arslan, M.E.; Balbay, Mevlana Derya

doi:10.1007/s11255-016-1449-y

Cited by 16 publications

(10 citation statements)

References 24 publications

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“…When ST was changed to supine position (T5), IOP recovered to the level similar to that at baseline (T1), although it was slightly elevated again at T6 most probably due to the withdrawal of anesthesia. In addition, we found that the console time significantly affected the increase in IOP during RARP at a cut-off of 4 h. There is another report on the effect of ST on IOP during robotic surgery including 43 RALP cases [6]. The authors found that the highest IOP was at the end of ST under pneumoperitoneum which is in perfect agreement with our findings.…”

Section: Discussionsupporting

confidence: 91%

Intraoperative intraocular pressure changes during robot-assisted radical prostatectomy: associations with perioperative and clinicopathological factors

et al. 2020

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Background: Steep Trendelenburg position (ST) during robot-assisted radical prostatectomy (RARP) poses a risk of increase in intraocular pressure (IOP) in men receiving robot-assisted radical prostatectomy (RARP). The aim of the study was to identify clinicopathological factors associated with increased IOP during RARP. Methods: We prospectively studied 59 consecutive prostate cancer patients without glaucoma. IOP was measured at 6 predefined time points before, during and after the operation (T1 to T6). Results: Compared with T1, IOP decreased after beginning of anesthesia(T2) (by − 6.5 mmHg, p < 0.05), and increased 1 h after induction of pneumoperitoneum in the steep Trendelenburg position (ST) (T3) (+ 7.3 mmHg, p < 0.05). IOP continued to increase until the end of ST (T4) (+ 10.2 mmHg, p < 0.05), and declined when the patient was returned to supine position under general anesthesia (T5) (T1: 20.0 and T5: 20.1 mmHg, p above 0.05). The console time affected the elevation of IOP in ST; IOP elevation during ST was more prominent in men with a console time of ≥4 h (n = 39) than in those with a console time of < 4 h (n = 19) (19.8 ± 6.3 and 15.4 ± 5.8 mmHg, respectively, p < 0.05). Of the 59 patients, 29 had a high baseline IOP (20.0 mmHg or higher), and their IOP elevated during ST was also reduced at T5 (T1: 22.6 and T5: 21.7 mmHg, p above 0.05). There were no postoperative ocular complications. Conclusions: Console time of < 4 h is important to prevent extreme elevation of IOP during RARP. Without long console time, RARP may be safely performed in those with relatively high baseline IOP.

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Section: Discussionsupporting

confidence: 91%

Intraoperative intraocular pressure changes during robot-assisted radical prostatectomy: associations with perioperative and clinicopathological factors

et al. 2020

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“…Ischemic optic neuropathy, which is a rare complication, was reported after robotic and laparoscopic radical prostatectomy [54] . Corneal abrasions may occur because of chemosis or exposure keratopathy [55] . Eye patchings and transparent occlusive dressings are recommended to prevent corneal abrasions.…”

Section: Ocular Complications and Edemamentioning

confidence: 99%

Complications of robotic and laparoscopic urologic surgery relevant to anesthesia

Arslan¹,

Özgök²

2018

MIS

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How to cite this article: Arslan ME, Özgök A. Complications of robotic and laparoscopic urologic surgery relevant to anesthesia. AbstractTechnology keeps advancing in this era allowing surgery to become less invasive in many surgical sciences. Besides these technological advances, minimally invasive procedures such as laparoscopy and robotic assisted laparoscopy are preferred widely around the globe by both surgeons and patients. Because of the increasing demand to laparoscopy and robotic surgery, anesthetists also should adapt to these specific surgical procedures. Carbon dioxide (CO 2 ) insufflation is applied in these procedures in order to provide working space and exposure to target organs. CO 2 insufflation (pneumoperitoneum if applied intrabdominally) and positional maneuvers such as steep Trendelenburg position is used in urologic laparoscopy and robotic surgery, which have vital effects on patient's physiology regarding cardiovascular, respiratory, renal, ocular and neurological systems. Special positions and unique surgical tools used in these procedures may hinder vital interventions such as cardiopulmonary resuscitation and open conversion. Comprehension of these pathophysiological effects and specific considerations is crucial to detect, to prevent and to manage serious complications that may occur during surgery.

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“…Recently, several prospective clinical studies have been carried out to evaluate the effects on visual function in patients undergoing RALP . However, most studies excluded patients with pre‐existing ocular diseases, and included healthy patients who were favorable for RALP.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 Recently, several prospective clinical studies have been carried out to evaluate the effects on visual function in patients undergoing RALP. [5][6][7][8][9][10][11][12][13] However, most studies excluded patients with pre-existing ocular diseases, and included healthy patients who were favorable for RALP. Thus far, there has been no prospective assessment regarding RALP for patients with ocular diseases, except for a case report; a glaucomatous patient who underwent RALP without any severe ocular damage was reported on, and how to monitor and manage elevated IOP during RALP was described.…”

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confidence: 99%

Prospective evaluation of visual function in patients with ocular diseases after robot‐assisted laparoscopic prostatectomy

et al. 2020

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Objectives To investigate intraocular pressure and visual function in patients with ocular diseases undergoing robot‐assisted laparoscopic prostatectomy. Methods We carried out a prospective clinical study of patients undergoing robot‐assisted laparoscopic prostatectomy for localized prostate cancer at The University of Tokyo Hospital from December 2015 to March 2017. An ophthalmologist measured intraocular pressure, and carried out visual field testing at 0–2 months before and 7 days after robot‐assisted laparoscopic prostatectomy. During the surgery, an anesthesiologist measured intraocular pressure at specified time points. Results A total of 110 patients were enrolled and 98 eligible patients were analyzed; 37 were diagnosed with ocular diseases before robotic‐assisted laparoscopic prostatectomy (17 with glaucoma, 20 with other ocular diseases). Intraocular pressure significantly increased during robot‐assisted laparoscopic prostatectomy. Transient postoperative visual field defect was detected in 24 eyes of 17 patients, including six patients with ocular diseases at 7 days after surgery. At 3 months after surgery, one of 34 glaucomatous eyes and one of 40 eyes with non‐glaucomatous ocular diseases continued to show visual field defect, although visual field defect in the remaining patients recovered to preoperative conditions within 3 months. Conclusions Our findings suggest that robot‐assisted laparoscopic prostatectomy can be safely carried out in patients with ocular diseases, even those with glaucoma, after precautionary consultation with an ophthalmologist.

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Does steep Trendelenburg positioning effect the ocular hemodynamics and intraocular pressure in patients undergoing robotic cystectomy and robotic prostatectomy?

Abstract: Despite staying in the ST for a long time provided that the ophthalmologic examination was normal, ocular complication risk is low in robotic prostatectomy and cystectomy.

Cited by 16 publications

References 24 publications

Intraoperative intraocular pressure changes during robot-assisted radical prostatectomy: associations with perioperative and clinicopathological factors

Intraoperative intraocular pressure changes during robot-assisted radical prostatectomy: associations with perioperative and clinicopathological factors

Complications of robotic and laparoscopic urologic surgery relevant to anesthesia

Prospective evaluation of visual function in patients with ocular diseases after robot‐assisted laparoscopic prostatectomy

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