The Effect of the Modified Z Trendelenburg Position on Intraocular Pressure during Robotic Assisted Laparoscopic Radical Prostatectomy: A Randomized, Controlled Study

Raz, Orit E.; Boesel, Tillman; Arianayagam, Mohan; Lau, Howard; Vass, Justin; Huynh, Chi Can; Graham, Stuart L.; Varol, Celi

doi:10.1016/j.juro.2014.10.094

Cited by 30 publications

(25 citation statements)

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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%

“…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. At 7 days after RALP, IOP returned to near preoperative levels, as previously described . Interestingly, IOP in patients with ocular diseases, even with glaucoma, changed by the same amount as healthy patients; this is in contrast to a previous study that reported dramatic elevation in IOP among patients with glaucomatous or vascular eye disease .…”

Section: Discussionsupporting

confidence: 61%

“…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%

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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%

Section: Discussionsupporting

confidence: 61%

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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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“…Raz et al applied a modified Z-TP during RALP and found a significant positive effect on patient neuro-ocular safety by lowering intraocular pressure without any negative effects on surgery. Increased IOP can also be reduced by drugs [19]. In a study by Molloy et al, 32.5% of patients undergoing lengthy laparoscopic surgery in STP had an IOP higher than 40 mmHg [20].…”

Section: Discussionmentioning

confidence: 99%

Changes in intraocular pressure and optic nerve sheath diameter in patients undergoing robotic-assisted laparoscopic prostatectomy in steep 45° Trendelenburg position

et al. 2017

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BackgroundTo evaluate changes in intraocular pressure (IOP) and intracerebral pressure (ICP) reflected by the optic nerve sheath diameter (ONSD) in patients undergoing robotic-assisted laparoscopic prostatectomy (RALP) in permanent 45° steep Trendelenburg position (STP).MethodsFifty-one patients undergoing RALP under a standardised anaesthesia. IOP was perioperatively measured in awake patients (T0) and IOP and ONSD 20 min after induction of anaesthesia (T1), after insufflation of the abdomen in supine position (T2), after 30 min in STP (T3), when controlling Santorini’s plexus in STP (T4) and before awakening while supine (T5). We investigated the influence of respiratory and circulatory parameters as well as patient-specific and time-dependent factors on IOP and ONSD.ResultsAverage IOP values (mmHg) were T0 = 19.9, T1 = 15.9, T2 = 20.1, T3 = 30.7, T4 = 33.9 and T5 = 21.8. IOP was 14.0 ± 7.47 mmHg (mean ± SD) higher at T4 than T0 (p = 0.013). Univariate mixed effects models showed peak inspiratory pressure (PIP) and mean arterial blood pressure (MAP) to be significant predictors for IOP increase. Mean ONSD values (mm) were T1 = 5.88, T2 = 6.08, T3 = 6.07, T4 = 6.04 and T5 = 5.96. The ONSD remained permanently >6.0 mm during RALP. Patients aged <63 years showed a 0.21 mm wider ONSD on average (p = 0.017) and greater variations in diameter than older patients.ConclusionsThe combination of STP and capnoperitoneum during RALP has a pronounced influence on IOP and, to a lesser degree, on ICP. IOP is directly correlated with increasing PIP and MAP. IOP doubled and the ONSD rose to values indicating increased intracranial pressure. Differences in the ONSD were age-related, showing higher output values as well as better autoregulation and compliance in STP for patients aged <63 years. Despite several ocular changes during RALP, visual function was not significantly impaired postoperatively.Trial registration Z-2014-0387-6. Registered 8 July 2014.

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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%

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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The Effect of the Modified Z Trendelenburg Position on Intraocular Pressure during Robotic Assisted Laparoscopic Radical Prostatectomy: A Randomized, Controlled Study

Cited by 30 publications

References 13 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

Changes in intraocular pressure and optic nerve sheath diameter in patients undergoing robotic-assisted laparoscopic prostatectomy in steep 45° Trendelenburg position

Intraocular Pressure Changes With Positioning During Laparoscopy

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