Are you seeing this: the impact of steep Trendelenburg position during robot-assisted laparoscopic radical prostatectomy on intraocular pressure: a brief review of the literature

Abstract

With the increasing popularity, frequency, and acceptance of the robotic-assisted laparoscopic radical prostatectomy procedure, an awareness of unique intra- and postoperative complications is heightened, including that of increases in intraocular pressure. The steep Trendelenburg positioning required for operative exposure has been shown to increase this value. While the literature is infrequent and undeveloped, certain anesthetic parameters including deep neuromuscular blockade, modified positioning, and the use of dexmedetomidine have been shown to have mild-to-modest decreases in intraocular pressure for baseline. In the four randomized control trials and four observational studies that were found via PubMed/Medline search, the aforementioned techniques demonstrate some preliminary evidence of operative considerations in this unique patient population. These modifications may prove to have even greater significance in patients with pre-existing ophthalmologic pathologies, such as glaucoma, which were excluded from the studies' analyses. This review summarizes the early literature obtained in this subject, with the intent of emphasizing the initial hypotheses and identifying areas for future study.

The first series of laparoscopic radical cystectomies done in South Africa

“…These include raised airway pressure with atelectasis, cerebral and facial oedema, raised intra-ocular pressure, and traction on lower limbs with neuropraxia. 10,11 No documented cases of these complications were noted in this cohort of patients.…”

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

“…The latest review of IOP during RALP introduced four randomized controlled trials focusing on how to lower IOP during RALP, and four prospective observational studies to examine visual function including IOP during RALP . To the best of our knowledge, the present study was the first and largest prospective study to evaluate IOP and visual field sensitivity during RALP in the patients with ocular diseases.…”

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

“…Increased central venous pressure, pneumoperitoneum with carbon dioxide, and increased airway pressure have been proposed [2,10] as mechanisms affecting IOP elevation in patients in the ST. Increased central venous pressure due to ST raises the upper scleral venous pressure and suppresses the outflow of aqueous humor.…”

“…With pneumoperitoneum, increased amounts of carbon dioxide dissolve in the blood and decrease the ventilation volume due to compression of the diaphragm, causing hypercapnemia, and the IOP rises because the choroidal vascular volume increases due to vasodilation. Excessive increase in airway pressure due to ST raises intrathoracic pressure and thereby increases central venous pressure [10].…”