Trendelenburg Position in Gynecologic Robotic-Assisted Surgery

Ghomi, Ali; Kramer, Christina E.; Askari, Reza; Chavan, Niraj R.; Einarsson, Jon I.

doi:10.1016/j.jmig.2012.03.019

Cited by 59 publications

(33 citation statements)

References 21 publications

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“…We chose to standardize the degree of the Trendelenburg position in our population to 30°. Pelvic surgery may be safely completed at lower Trendelenburg angles [14]. However, to our knowledge, no studies have specifically evaluated patient displacement at various Trendelenburg angles.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Memory Foam Pad Versus the Bean Bag with Shoulder Braces in Preventing Patient Displacement during Gynecologic Laparoscopic Surgery

Farag

Rosen

Ascher‐Walsh

2018

Journal of Minimally Invasive Gynecology

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Section: Discussionmentioning

confidence: 99%

Comparison of the Memory Foam Pad Versus the Bean Bag with Shoulder Braces in Preventing Patient Displacement during Gynecologic Laparoscopic Surgery

Farag

Rosen

Ascher‐Walsh

2018

Journal of Minimally Invasive Gynecology

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“…But high head down angles (40–45°) may not actually be necessary. 15 Corneal or conjunctival edema may also occur from increased central venous pressure 16 and raised IOP, causing further stress to the eye via direct fluid pressure on the globe, or pressure causing the eyes to tend to remain open. Further support for these hypotheses is that IOP increased when patients were positioned prone for spine surgery, which has also been associated with a higher incidence of CAs.…”

Section: Discussionmentioning

confidence: 99%

Corneal Abrasion in Hysterectomy and Prostatectomy

et al. 2015

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Background Radical prostatectomy (RP) is most commonly performed laparoscopically with a robot (robotic-assisted laparoscopic radical prostatectomy, R/PROST). Hysterectomy, which may be open hysterectomy (O/HYST), or laparoscopic (L/HYST), has been increasingly frequently done via robot (R/HYST). Small case series suggest increased corneal abrasions (CA) with less invasive techniques. Methods We identified RP (166,942), O/HYST (583,298), or L/HYST (216,890) discharges with CA in the Nationwide Inpatient Sample (2000–2011). For 2009–11, we determined odds ratios (OR) and 95% confidence intervals (CI) for CA, in R/PROST, non-R/PROST, L/HYST, O/HYST, and R/HYST. Uni- and multivariate models studied CA risk depending upon surgical procedure, age, race, year, chronic illness, and malignancy. Results In 2000–11, 0.18% RP, 0.13% L/HYST, and 0.03% O/HYST sustained CA. Compared to 17,554 non-R/PROSTs (34 abrasions, 0.19%) in 2009–11, OR was not significantly higher in 28,521 R/PROSTs (99, 0.35%; OR 1.508, CI 0.987–2.302, P < 0.057). CA significantly increased in L/HYST (70/51,323; 0.136%) vs O/HYST (70/191,199; 0.037%, OR 3.821, CI 2.594–5.630, P < 0.0001), further increasing in R/HYST (63/21, 213; 0.297%, OR 6.505, CI 4.323–9.788, P < 0.0001). For hysterectomy, risk of CA increased with age (OR 1.020, CI 1.007–1.034, P < 0.003), and number of chronic conditions (OR 1.139, CI 1.065–1.219, P < 0.0001). CA risk was likewise elevated in R/HYST with number of chronic conditions. Being African-American significantly decreased CA risk in R/PROST and in R/ or L/HYST. Conclusions L/HYST increased CA nearly 4-fold, and R/HYST about 6.5-fold vs O/HYST. Identifiable preoperative factors are associated with either increased risk (age, chronic conditions) or decreased risk (race).

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“…Not only is patient access limited once the robot arms are in place [28], but exaggerated Trendelenburg positioning and pneumoperitoneum have been shown to decrease venous outflow from the head, increase intraocular pressure, worsen ventilation-perfusion mismatch, and increase systemic catecholamine release [29]. Indeed, venous pooling in the head and neck during extended periods of Trendelenburg has resulted in laryngeal edema [9].…”

Section: Methodsmentioning

confidence: 99%

The second “time-out”: a surgical safety checklist for lengthy robotic surgeries

et al. 2013

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Robotic surgeries of long duration are associated with both increased risks to patients as well as distinct challenges for care providers. We propose a surgical checklist, to be completed during a second “time-out”, aimed at reducing peri-operative complications and addressing obstacles presented by lengthy robotic surgeries. A review of the literature was performed to identify the most common complications of robotic surgeries with extended operative times. A surgical checklist was developed with the goal of addressing these issues and maximizing patient safety. Extended operative times during robotic surgery increase patient risk for position-related complications and other adverse events. These cases also raise concerns for surgical, anesthesia, and nursing staff which are less common in shorter, non-robotic operations. Key elements of the checklist were designed to coordinate operative staff in verifying patient safety while addressing the unique concerns within each specialty. As robotic surgery is increasingly utilized, operations with long surgical times may become more common due to increased case complexity and surgeons overcoming the learning curve. A standardized surgical checklist, conducted three to four hours after the start of surgery, may enhance perioperative patient safety and quality of care.

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Trendelenburg Position in Gynecologic Robotic-Assisted Surgery

Cited by 59 publications

References 21 publications

Comparison of the Memory Foam Pad Versus the Bean Bag with Shoulder Braces in Preventing Patient Displacement during Gynecologic Laparoscopic Surgery

Comparison of the Memory Foam Pad Versus the Bean Bag with Shoulder Braces in Preventing Patient Displacement during Gynecologic Laparoscopic Surgery

Corneal Abrasion in Hysterectomy and Prostatectomy

The second “time-out”: a surgical safety checklist for lengthy robotic surgeries

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