Ocular complications in robotic surgery

Gkegkes, Ioannis D.; Karydis, Andreas; Tyritzis, Stavros Ι.; Iavazzo, Christos

doi:10.1002/rcs.1632

Cited by 31 publications

(36 citation statements)

References 18 publications

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“…When bilateral lymphadenectomy is performed, the transperitoneal technique seems to be more efficient in comparison to the extraperitoneal approach which can be technically more challenging. Alternately, the potential disadvantages of the technique could include the risk of bowel injury or accidental perforation, the risk of vascular injuries, the probability of ileus due to a blood or urine leak and the need of severe Trendelenburg positioning of the patient which may have deep impact especially on patients with cardiopulmonary problems and increased intraocular pressure [16,32].…”

Section: Discussionmentioning

confidence: 99%

Robotic retroperitoneal lymph node dissection in gynaecological neoplasms: comparison of extraperitoneal and transperitoneal lymphadenectomy

Iavazzo

Gkegkes

2015

Arch Gynecol Obstet

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Section: Discussionmentioning

confidence: 99%

Robotic retroperitoneal lymph node dissection in gynaecological neoplasms: comparison of extraperitoneal and transperitoneal lymphadenectomy

Iavazzo

Gkegkes

2015

Arch Gynecol Obstet

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“…The tendency of eyes to incompletely close during general anaesthesia predisposes patients to this risk. 50 Other risk factors included conjunctival oedema and lack of covering eye tape 40 , fluid administration greater than two litres, 51 and robotic vs purely laparoscopic cases. 52 Potential causes also included direct contact with patient eyes by the patient or provider 40 and monitoring cables in proximity to the eyes.…”

Section: Corneal Abrasions (Ca)mentioning

confidence: 99%

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

Maerz

Beck

Sim

et al. 2017

British Journal of Anaesthesia

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With the ever-increasing popularity of robotic-assisted laparoscopic surgery over the past decades, the literature reporting complications distant from the surgical site involving the use of this technology has also grown. The goal of this non-systematic review is to summarise these reports with a systems-based presentation of these complications. The most commonly observed complications were related to the peripheral nervous system and the most devastating occurring in cardiac and ophthalmic systems. There were no reports of patient complications directly related to the robot itself. While several of the reported complications are not unique to robotic surgery, they are included to maintain awareness of their possibility. The limitation of surgical time, judicious fluid administration, and constant vigilance of patient positioning are all recommended as possible preventative measures.

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“…The ischemic process can occur as a direct result of decreased blood supply from the arteries of the optic nerve or by venous stasis that occurs as a result of decreased venous outflow and a compartment syndrome of the optic nerve or optic canal. 25,39,43 The subsequent postoperative vision loss can range from temporary blurring to partial to complete blindness; however, once a loss of vision occurs, it is almost always an irreversible complication. 1,2 Central Retinal Artery Occlusion Central retinal artery occlusion is most often caused by pressure on the eye from the prone position, and especially by positioning the patient's head on a prominent headrest.…”

Section: Introductionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Prone Position on Intraocular Pressure in Adults Undergoing Surgery

Wicklin

2020

Int J Spine Surg

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Background: Patients undergoing surgery in the prone position may be at risk for postoperative vision loss associated with increased intraocular pressure. The purpose of this systematic review and meta-analysis is to estimate the magnitude of the increase in intraocular pressure at specific perioperative time points in adult patients. The research question to be addressed is ''What is the magnitude of the increase in intraocular pressure at specific perioperative time points in adults undergoing surgery in the prone position?''Methods: Comprehensive search strategies were used to identify nine eligible studies (N ¼ 229). Standardized mean difference effect sizes were calculated for two intraoperative time points. Time points for meta-analysis were selected to achieve the greatest number of comparisons for analysis at each time point. Prediction intervals for each time point were also calculated to show the dispersion of true effect sizes around the mean.Results: Meta-analysis showed that intraocular pressure increased significantly between induction of anesthesia and up to 10 minutes of prone position (T1: standardized mean difference [d] ¼ 2.55; P , .001) and continued to increase significantly until the end of the prone position (T2: d ¼ 3.44; P ¼ .002).Conclusions: Intraocular pressure increases of this magnitude demonstrate the need for implementing interventions to reduce the risk for postoperative vision loss in patients undergoing surgery in the prone position.Clinical Relevance: Implementing preoperative ophthalmologic examinations for patients undergoing surgery in the prone position may help to reduce the risk for ocular injury. Intraoperative interventions that can be implemented to reduce or mitigate the increase in intraocular pressure include implementing a 5-to 10-degree reverse Trendelenburg prone position, reducing the amount of time the patient is in the prone position, considering staged procedures, monitoring intraocular pressure, providing periodic position changes or rest periods, preventing pressure on the eye, and administering specific medications or anesthetics. ComplicationsKeywords: intraocular pressure, prone position, ischemic optic neuropathy, central retinal artery occlusion Pathogenesis of Postoperative Vision LossPostoperative vision loss in patients undergoing surgery in the prone position is generally related to 1 PurposeAlthough some researchers have studied the quantitative increase of IOP in surgical patients in the prone position, 1,2,14,16,17,34,50 there is a need for systematic review and meta-analyses of these studies to demonstrate the overall effect size and provide high-quality evidence supporting, or negating, the

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Ocular complications in robotic surgery

Cited by 31 publications

References 18 publications

Robotic retroperitoneal lymph node dissection in gynaecological neoplasms: comparison of extraperitoneal and transperitoneal lymphadenectomy

Robotic retroperitoneal lymph node dissection in gynaecological neoplasms: comparison of extraperitoneal and transperitoneal lymphadenectomy

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

Systematic Review and Meta-Analysis of Prone Position on Intraocular Pressure in Adults Undergoing Surgery

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