Robotic-assisted hysterectomy in a patient with a ventriculoperitoneal shunt

Abstract

There are several articles in the literature reporting laparoscopic surgery in patients with ventriculoperitoneal shunts (VPSs). Although the majority of these conclude that a pneumoperitoneum in these patients is safe, there are other reports indicating possible complications of the insufflation. This is the first known report of a robotic-assisted hysterectomy performed on a patient with a VPS and the management of the shunt during the procedure.

Laparoscopic Intervention after Ventriculoperitoneal Shunt: A Case Report, Systematic Review, and Recommendations

“…There is only one case of robotic surgery (hysterectomy) and it was successful. 33 It is an important case, because the Trendelenburg position in robotic surgery is steeper and there is no possibility of changing the degree of the Trendelenburg position after the docking. In this report, the authors temporarily clamped the shunt and the pressure throughout the operation was held at 12 mm Hg.…”

“…27,39 The anesthesiologist should always inform the surgeon about the signs of increased ICP such as bradycardia and hypertension. 33 A pelvic operation, lasting many hours, can affect the surgeons' ability to monitor the shunt, and this could potentially 27 be the reason why any occlusions or back-pressure problems are overseen. In these cases, an intermittent release of the pneumoperitoneum, reduction of the Trendelenburg position, and inspection of the end of the shunt would give a possibility to avoid such complications.…”

“…The pressure used for the pneumoperitoneum was between 8 mm Hg and 50 mm Hg, mostly 12 mm Hg. 1,2,8,10,17,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]39,40 The following complications occurred: one case of massive subcutaneous emphysema, 11 cases of conversion to laparotomy due to extensive inflammation, gangrenous situation, 10,20 a large tumor, and adhesions. 21,36 One case of shunt failure directly after the operation, 24 eight cases of postoperative VP shunt removal or revision due to infection, 1,2,8,10 one case of multiple organ failure and death, 20 and one case of pneumocephalus.…”

“…38 In all the cases the traditional laparoscopy was used, except for one where robotic hysterectomy was carried out. 33 The first reported case of laparoscopic surgery having complications with a VP shunt was described by Schwed et al 19 They reported a 73-year-old woman who underwent a laparoscopic cholecystectomy 10 days after the insertion of a VP shunt. She suffered subcutaneous emphysema and impaired respiratory condition directly after the procedure.…”