Ocular Complications in Laparoscopic Surgery: Review of Existing Literature and Possible Prevention and Treatment

Abstract

During laparoscopic surgery, ocular complications are possible, sometimes leading to devastating visual losses, hardly susceptible to recovery, although rare. Principal ocular adverse events are represented by corneal abrasions and the perioperative visual loss (POVL). POVL onset is related to intraocular pressure elevations (particularly after patient positioning in Trendelenburg or prone decubitus, depending on the surgical procedure), anesthesiologic factors and patients' characteristics. In the light of evidence from the existing literature, the authors suggest surgical and anesthesiologic measures to prevent and manage ocular complications in laparoscopic surgery. Apart from general recommendations, this article indicates practical guidelines specific for robot-assisted laparoscopic interventions and spinal surgery, as well as laparoscopic colorectal resection, radical prostatectomy, and gynecologic surgery. In conclusion, in order to better manage these complications, it is advisable to develop an interdisciplinary collaboration between surgeons, anesthesiologists, and ophthalmologists, on a procedural and medico-legal level, with the intent of mutual training.

Anesthesia for gynecological endoscopic surgery

“…Takođe zbog povećanja intraokularnog pritiska treba biti oprezan kod pacijenata sa glaukomom jer se može javiti postoperativno slepilo. 27 Kompartment sindrom donjih ekstremiteta: nastaje kod dugotrajnih operacija u ektremnom Trendeleburgovom položaju koju prate loša arterijska perfuzija, kompresija venskih sudova nogu i loša venska drenaža iz femoralnih vena zbog PP. Simptomi ovog retkog stanja su bol, rabdomioliza i akutna bubrežna insufi cijencija.…”

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

“…25,[29][30][31][32][33][34] After only a few minutes in the prone position, IOP can increase significantly. 35 According to the American Academy of Ophthalmology, 36 normal IOP is 10 to 21 mm Hg. Intraocular pressures higher than 21 mm Hg pose a risk for glaucoma, detached retina, and postoperative vision loss.…”

Histeroskopik Cerrahide Göz içi Basıncının Değerlendirilmesi

“…11 Th e type of anesthesia, the patient's intraoperative posture, and its duration and the fl uids utilized during hysteroscopy may fl uctuate the IOP. 12 Sudden peaks of IOP may decrease ocular perfusion pressure which is calculated by the dif-ference between mean systemic arterial pressure and IOP, and that may aggravate several ocular diseases such as retinal ischemia and glaucoma. 13 Currently, non-invasive intraoperative IOP measurement is available by portable digital tonometer devices which do not require specially trained staff .…”

“…Th us, the signifi cant IOP increase in both groups can be explained by the intraoperative posture. It was suggested that elevating the head over the heart level may decrease the episcleral pressure, hence the IOP peaks can be prevented 12. Th e prolonged operational times eventually increase fl uid input.…”