Intraocular Pressure During Robotic-assisted Laparoscopic Procedures Utilizing Steep Trendelenburg Positioning

Mondzelewski, Todd; Schmitz, Joseph W.; Christman, Matthew; Davis, Kimberly; Lujan, Eugenio; L’Esperance, James O.; Auge, Brian K.

doi:10.1097/ijg.0000000000000302

Cited by 31 publications

(28 citation statements)

References 19 publications

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“…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. We showed that IOP significantly increased during TP in RALP in a time‐dependent manner, as previously described . Regarding the degree of elevation of IOP, at 3 h after TP, glaucomatous patients showed significantly lower IOP change, partly because of perioperative ophthalmic drops to maintain IOP within the normal range.…”

Section: Discussionsupporting

confidence: 83%

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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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Section: Discussionsupporting

confidence: 83%

“…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%

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

et al. 2020

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“…31 Intraocular pressure assessed in patients with head-down (Trendelenburg) surgical positioning has been found to increase, however, retinal nerve fiber layer thickness measured with optical coherence tomography does not appear to be altered in patients with vision impairments after surgery. 32, 33 Similarly, no clinically relevant findings were found during 14 day exposure to −6° HDT bed rest, 34 whereas 70 day −6° HDT bed rest could provoke an increase in the superior, nasal, and inferior peripapillary retinal thickness. 35 …”

Section: Discussionmentioning

confidence: 98%

MRI-derived diffusion parameters in the human optic nerve and its surrounding sheath during head-down tilt

et al. 2017

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More than half of astronauts present with significant neuro-ophthalmic findings during 6-month missions onboard the International Space Station. Although the underlying cause of this Microgravity Ocular Syndrome is currently unknown, alterations in cerebrospinal fluid dynamics within the optic nerve sheath may play a role. In the presented study, diffusion tensor imaging was used to assess changes in diffusivity of the optic nerve and its surrounding sheath during head-down tilt, a ground-based model of microgravity. Nine healthy male subjects (mean age ± SD: 25 ± 2.4 years; mean body mass index ± SD: 24.1 ± 2.4 kg/m2) underwent 5 head-down tilt conditions: −6°,−12°, −18°,−12° and 1% CO2, and −12° and lower body negative pressure. Mean diffusivity, fractional anisotropy, axial diffusivity, radial diffusivity were quantified in the left and right optic nerves and surrounding sheaths at supine baseline and after 4.5 h head-down tilt for each condition. In the optic nerve sheath, mean diffusivity was increased with all head-down tilt conditions by (Best Linear Unbiased Predictors) 0.147 (SE: 0.04) × 10−3 mm2/s (P < 0.001), axial diffusivity by 0.188 (SE: 0.064) × 10−3 mm2/s (P < 0.001), and radial diffusivity by 0.126 (SE: 0.04) × 10−3 mm2/s (P = 0.0019). Within the optic nerve itself, fractional anisotropy was increased by 0.133 (SE: 0.047) (P = 0.0051) and axial diffusivity increased by 0.135 (SE: 0.08) × 10−3 mm2/s (P = 0.014) during head-down tilt, whilst mean diffusivity and radial diffusivity were unaffected (P > 0.3). These findings could be due to increased perioptic cerebral spinal fluid hydrodynamics during head-down tilt, as well as increased cerebral spinal fluid volume and movement within the optic nerve sheath.

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“…Many of the studies highlighting POVL and markedly elevated IOP changes (reaching glaucomatous range) after laparoscopic surgery had been performed with steep Trendelenburg position or in prolonged procedures. 12–14,19,21,22,24,25 Mondzelewski et al 22 observed a significantly elevated IOP in patients undergoing robot-assisted laparoscopic procedures in steep Trendelenburg position compared with IOP in those undergoing laparoscopy or open procedures in a horizontal position, further highlighting the role of positioning over and above that of pneumoperitoneum in significant IOP elevations. A recent study performed among patients undergoing laparoscopic colorectal surgery showed greater IOP elevation in both eyes of patients in Trendelenburg position during the surgical procedure, but found no substantial difference between the Trendelenburg and non-Trendelenburg group when IOP was measured 48 hours after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…15–18 With this in mind, in many studies, researchers have investigated the relationship between IOP changes during laparoscopy and different anaesthetic agents employed, whereas few have investigated the role of steep Trendelenburg position on IOP changes. 19–22 The changes in IOP with normal Trendelenburg and reverse Trendelenburg positions have not been fully investigated. We sought therefore to evaluate the changes in IOP with such changes in patient position during laparoscopic surgeries.…”

Section: Introductionmentioning

confidence: 99%

Intraocular Pressure Changes With Positioning During Laparoscopy

Adisa¹,

Onakpoya

Adenekan

et al. 2016

JSLS

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Background and Objectives:Pneumoperitoneum during laparoscopy can produce changes in intraocular pressure (IOP) that may be influenced by several factors. In this study, we investigated changes in IOP during laparoscopy with different positioning.Methods:We recruited adult patients without eye disease scheduled to undergo laparoscopic operation requiring a reverse Trendelenburg tilt (rTr; group A; n = 20) or Trendelenburg tilt (Tr; Group B; n = 20). IOP was measured at 7 time points (T1–T7). All procedures were performed with standardized anaesthetic protocol. Mean arterial pressure (MAP), heart rate (HR), peak and plateau airway pressure, and end-tidal carbon dioxide (ETCO2) measurements were taken at each time point.Results:Both groups were similar in age, sex, mean body mass index (BMI), duration of surgery, and preoperative IOP. A decrease in IOP was observed in both groups after induction of anaesthesia (T2), whereas induction of pneumoperitoneum produced a mild increase in IOP (T3) in both groups. The Trendelenburg tilt produced IOP elevations in 80% of patients compared to 45% after the reverse Trendelenburg tilt (P = .012). A significant IOP increase of 5 mm Hg or more was recorded in 3 (15%) patients in the Trendelenburg tilt group and in none in the reverse Trendelenburg group. At T7, IOP had returned to preoperative levels in all but 3 (15%) in the Trendelenburg and 1 (5%) in the reverse Trendelenburg group. Reversible changes were observed in the MAP, HR, ETCO2, and airway pressures in both groups.Conclusions:IOP changes induced by laparoscopy are realigned after evacuation of pneumoperitoneum. A Trendelenburg tilt however produced significant changes that may require careful patient monitoring during laparoscopic procedures.

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Intraocular Pressure During Robotic-assisted Laparoscopic Procedures Utilizing Steep Trendelenburg Positioning

Abstract: Significant elevations of IOP are experienced during robotic surgery utilizing sTBURG positioning in patients with healthy eyes, and we recommend a multidisciplinary approach in determining potential risk to those with known ocular disease who are candidates for these procedures.

Cited by 31 publications

References 19 publications

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

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

MRI-derived diffusion parameters in the human optic nerve and its surrounding sheath during head-down tilt

Intraocular Pressure Changes With Positioning During Laparoscopy

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