The Effect of Steep Trendelenburg Positioning on Retinal Structure and Function during Robotic-Assisted Laparoscopic Procedures

Abstract

Purpose Robotic-assisted laparoscopic radical prostatectomy (RALP) has become a standard treatment choice for localized prostate cancer. RALP requires a steep Trendelenburg position, which leads to a significant increase in intraocular pressure (IOP). This study evaluated the effect on the retinal structure and function in patients undergoing RALP. Methods Standard automated perimetry (SAP) and optical coherence tomography (OCT) were performed in 20 males scheduled for RALP at 1 month and 1 day before the operation and at 1 and 3 months after the operation. IOP measurements were made in the supine position at 5 min after intubation under general anesthesia (T1), at 6 discrete time points (5, 30, 60, 120, 180, and 240 min; T2-7), and at 5 min after returning to a horizontal supine position (T8). Serial retinal nerve fiber layer (RNFL) thicknesses and visual field progression were assessed using the guided progression analysis software program. RNFL thickness progression and visual field progression were evaluated by event analysis. Results Average IOP (mmHg) for each time point was as follows: T1 = 12.3 ± 2.6, T2 = 20.4 ± 4.2, T3 = 23.3 ± 3.8, T4 = 24.0 ± 3.2, T5 = 24.3 ± 3.4, T6 = 27.1 ± 7.2, T7 = 29.8 ± 8.7, and T8 = 20.1 ± 4.4. During RALP, IOP significantly increased. There was no progression of the visual field and RNFL thickness after surgery or any other ocular complications found. Conclusions Although IOP significantly increased during RALP, there were no significant changes in the retinal structure and function between the pre- and postoperation observations.

Retinal Nerve Fiber Layer Thickness Progression after Robotic-Assisted Laparoscopic Radical Prostatectomy in Glaucoma Patients

“…Therefore, these authors concluded that the retinal pathologic changes were unlikely to be due to transient visual field defects. We recently examined normal subjects and reported that pre- and postoperative observations revealed no significant changes in the retinal structure and function [8]. Mathew et al also evaluated normal subjects at 1 month postoperatively and reported that none of the patients developed visual field or RNFL changes [12].…”

“…In order to be able to maintain both the eye structure and physiology, the IOP is an essential factor. Furthermore, previous studies have reported finding a correlation between intraoperative IOP changes and the clinical postoperative ophthalmological outcomes [6–8]. Taketani et al examined visual field defects at 1 week after surgery using optical coherence tomography (OCT) and reported finding that the visual field returned to normal within 3 months after the surgeries in all cases, even though there were no abnormal findings in the fundus, retinal nerve fiber layer (RNFL) thickness, or optic disc morphology [7].…”

“…Taketani et al examined visual field defects at 1 week after surgery using optical coherence tomography (OCT) and reported finding that the visual field returned to normal within 3 months after the surgeries in all cases, even though there were no abnormal findings in the fundus, retinal nerve fiber layer (RNFL) thickness, or optic disc morphology [7]. In contrast, we recently reported that despite all patients having an intraoperative increase in the IOP, their pre- and postoperative observations showed that none of these patients had any significant changes in the retinal structure and function [8].…”

Perioperative Care of the Patient with Eye Pathologies Undergoing Nonocular Surgery

“…Most studies of steep Trendelenburg positioning and robotic-assisted prostatectomy hysterectomy have small sample sizes and are in patients without glaucoma. 179,[194][195][196][197] The biggest study included 51 nonglaucomatous subjects who underwent robotic-assisted laparoscopic prostatectomy or hysterectomy while positioned in steep Trendelenburg. No changes were found at 3 months in retinal nerve fiber layer or ganglion cell complex thickness, foveal threshold, mean deviation, or pattern standard deviation.…”

Automatic Positioning and Recognition of Anesthesia Points Based on Ultrasound Image Guidance Technology

“…The propagation time of the ultrasonic signal measured by the signal receivers A and B is τ 1 , τ 2 . Assuming that the propagation speed of the ultrasonic signal in the air medium is c, the distance u and v between the positioning target and the signal receivers A and B can be calculated as [19].…”