Haemodynamics and cardiac function during robotic-assisted laparoscopic prostatectomy in steep Trendelenburg position

Robotic-assisted laparoscopic prostatectomy (RALP) is usually performed in steep Trendelenburg position, which can be associated with cardiac impairment due to positioning and capnoperitoneum. This study investigated haemodynamic consequences and cardiac function in this type of surgery and evaluated the hypothesis that steep Trendelenburg position and capnoperitoneum results in haemodynamic and ventricular impairment.

10 patients (ASA I-III) scheduled for RALP in steep Trendelenburg position with capnoperitoneum were prospectively studied. Heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) were recorded. Stroke volume variation (SVV) and cardiac output (CO) were measured using pulse-contour analysis. Further, cardiac function was assessed using trans-oesophageal echocardiography before positioning (T1) and 10 min (T2) and 60 min (T3) after implementation of steep Trendelenburg position and capnoperitoneum.

HR did not change statistically. MAP (T1, 69.7 ± 1.55; T2, 82.9 ± 3.05; T3, 79.4 ± 2.18 mmHg), CVP (T1, 7.7 ± 1.3; T2, 17.3 ± 2.01; T3, 16.9 ± 1.66 mmHg) and CO (T1, 4.0 ± 0.15; T2, 4.9 ± 0.26; T3, 4.9 ± 0.36 l/min) increased significantly at T2 and T3. Echocardiography showed no deterioration of left or right ventricular function. In one patient with pre-existing mitral valve insufficiency (I°) an aggravation of the insufficiency (III°) was observed. No other valve dysfunctions were observed.

The steep Trendelenburg position may improve haemodynamic function and does not deteriorate left or right ventricular function during RALP. However, mitral valve insufficiency may be aggravated by positioning and capnoperitoneum.