Risk Factors for Increased Intraocular Pressure and Ophthalmic Complications During Robot-Assisted Laparoscopic Prostatectomy

Abstract

Robot-assisted laparoscopic prostatectomy (RALP) is the most effective treatment option for prostate cancer. Special conditions of the operation affect intraocular pressure (IOP). The purpose of this review was to systematize new data on changes in IOP during RALP, to review the ophthalmic complications related to the robot-assisted approach, and to suggest measures to avoid such issues. A systematic search for articles of the contemporary literature was performed in PubMed database for complications in RALP procedures focused on positioning, access, and operative technique considerations. Several complications in RALP procedures can be avoided if the surgical team follows some key steps. Adequate patient positioning must avoid skin, peripheral nerve, and muscle injuries, and ocular and cognitive complications mainly related to steep Trendelenburg positioning in pelvic procedures. The robotic surgical team must be careful and work together to avoid possible complications. This review offers the first assessment of perioperative changes in IOP and ophthalmic complications during RALP and several steps in surgical planning to reach this goal. Further studies with a longer follow-up period are necessary to determine the clinical efficacy and safety of various types of general anesthesia.