Posterior Ischemic Optic Neuropathy After Minimally Invasive Prostatectomy

Weber, Eric; Colyer, Marcus H.; Lesser, Robert L.; Subramanian, Prem S.

doi:10.1097/wno.0b013e31815b9f67

Cited by 161 publications

(96 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Cases of visual impairment have been reported to occur in minimally invasive proctocolectomy, laparoscopic nephrectomy and robotic prostatectomy [45][46][47][48] . During robotic prostatectomy, increased intraocular pressure occurs due to prolonged duration in steep Trendelenburg position combined with CO2 insufflation of the abdomen.…”

Section: Perioperative Visual Loss In Other Surgeriesmentioning

confidence: 99%

Perioperative visual loss after spine surgery

Nickels¹,

Manlapaz²,

Farag³

2014

WJO

View full text Add to dashboard Cite

Perioperative visual loss (POVL) is an uncommon, but devastating complication that remains primarily associated with spine and cardiac surgery. The incidence and mechanisms of visual loss after surgery remain difficult to determine. According to the American Society of Anesthesiologists Postoperative Visual Loss Registry, the most common causes of POVL in spine procedures are the two different forms of ischemic optic neuropathy: anterior ischemic optic neuropathy and posterior ischemic optic neuropathy, accounting for 89% of the cases. Retinal ischemia, cortical blindness, and posterior reversible encephalopathy are also observed, but in a small minority of cases. A recent multicenter case control study has identified risk factors associated with ischemic optic neuropathy for patients undergoing prone spinal fusion surgery. These include obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration. These risk factors are thought to contribute to the elevation of venous pressure and interstitial edema, resulting in damage to the optic nerve by compression of the vessels that feed the optic nerve, venous infarction or direct mechanical compression. This review will expand on these findings as well as the recently updated American Society of Anesthesiologists practice advisory on POVL. There are no effective treatment options for POVL and the diagnosis is often irreversible, so efforts must focus on prevention and risk factor modification. The role of crystalloids versus colloids and the use of α-2 agonists to decrease intraocular pressure during prone spine surgery will also be discussed as a potential preventative strategy. Core tip: Perioperative visual loss (POVL) is an uncommon, but devastating complication that remains primarily associated with spine and cardiac surgery. The incidence and mechanisms of visual loss after surgery remain difficult to determine. Ischemic optic neuropathy accounts for the vast majority of these cases, with retinal ischemia, cortical blindness, and posterior reversible encephalopathy observed with low incidence. Recently identified risk factors include obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration. POVL is often permanent and untreatable, so prevention is key to limiting its impact. Nickels TJ, Manlapaz MR, Farag E. Perioperative visual loss after spine surgery. World J Orthop 2014; 5(2): 100-106 Available from:

show abstract

Section: Perioperative Visual Loss In Other Surgeriesmentioning

confidence: 99%

Perioperative visual loss after spine surgery

Nickels¹,

Manlapaz²,

Farag³

2014

WJO

View full text Add to dashboard Cite

show abstract

“…16 Beyond the obvious concern of preserving overall metabolic homeostasis and optimal brain perfusion, maintaining an acceptable PE 0 CO 2 tension is therefore imperative to minimize the risk of serious ocular consequences, such as complete bilateral visual loss. 17 Whereas PE 0 CO 2 monitoring has proven to be an acceptable alternative to arterial blood gas PCO 2 in many clinical circumstances, the utility of PE analysis is a sufficient guide for the management of the ventilation strategy in this clinical setting. We found that the arterial-to-PE 0 CO 2 tension difference of 1.06 kPa in the supine position increased to a maximum of 1.41 kPa after 2 h in the Trendelenburg position and tended to decrease back to normal pre-Trendelenburg values thereafter.…”

mentioning

confidence: 99%

Influence of steep Trendelenburg position and CO2 pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy

Kalmar

Foubert

Hendrickx

et al. 2010

British Journal of Anaesthesia

216

133

View full text Add to dashboard Cite

show abstract

“…However, more recently, it was found that prolonged steep Trendelenburg and pneumoperitoneum was tolerated well and that regional cerebral oxygenation was preserved in male patients undergoing Robotic-assisted laparoscopic radical prostatectomies [20]. Other risks of steep Trendelenburg also involve possible injury to the eye, even blindness, as intraocular pressures are elevated for long durations of robotic-assisted MIS [21] [22]. The elderly are at an increased risk as they have a higher incidence of pre-existing eye disease.…”

Section: Discussionmentioning

confidence: 99%

Impact of Age on Surgical Outcomes after Robot Assisted Laparoscopic Hysterectomies

Eddib¹,

Hughes²,

Aalto³

et al. 2014

View full text Add to dashboard Cite

Objective: To estimate the impact of patient's age on surgical outcomes in patients undergoing robotic hysterectomy. Methods: A retrospective review of prospectively collected cohort data for a consecutive series of patients undergoing gynecologic robotic surgery. Patient's age and perioperative variables were collected from the database, charts, and other hospital records of all patients undergoing robotic hysterectomy. Results: 399 patients underwent robotic surgery for gynecologic disease. 370 patients who were under age 70 were compared with 29 patients who were over age 70. When comparing all patients under age 70 with patients over age 70, the mean age was 48.4 and 77 (P < 0.05), mean BMI was 32.1 and 28.3 kg/m 2 (P < 0.05), mean procedure time was 185 and 211 minutes (min) (P = 0.09), mean console time was 123 and 148 min (P = 0.056), mean OR (Operating room) time was 237 and 273, mean EBL (Estimated blood loss) was 71 and 65 ml (P = 0.74), Hb (Hemoglobin) drop was 1.4 and 1.2 (P = 0.45), uterine weight was 212 and 95 gm (P = 0.98), and length of stay was 1.4 and 1.6 days (P = 0.33) ( Table 1). The patients over age 70, when procedures were combined, had a statistically significant lower mean BMI, uterine weight and longer Operating room (OR) time. However, when stratified by the type of procedure performed, there was no difference in surgery times among those under 70 and over 70 years of age. The elderly patients were more likely to have cancer, which was in almost half the elderly patients, and thus necessitate staging. Thus adding the performance of lymph node dissection likely resulted in the increased length of the surgery time that was noted in the combined group (Tables 1, 2). There were no operative deaths. Conclusions: Advanced age does not appear to be associated with an increased risk of morbidity, or adverse perioperative outcomes in patients undergoing robotic hysterectomy.

show abstract

Posterior Ischemic Optic Neuropathy After Minimally Invasive Prostatectomy

Cited by 161 publications

References 8 publications

Perioperative visual loss after spine surgery

Perioperative visual loss after spine surgery

Influence of steep Trendelenburg position and CO2 pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy

Impact of Age on Surgical Outcomes after Robot Assisted Laparoscopic Hysterectomies

Contact Info

Product

Resources

About