Intraocular Pressure During Robotic-assisted Laparoscopic Procedures Utilizing Steep Trendelenburg Positioning

Area of Science:

• Ophthalmology
• Surgical Technology
• Anesthesiology

Background:

• Robotic-assisted laparoscopy (RAL) often requires steep Trendelenburg (sTBURG) positioning.
• The impact of sTBURG on intraocular pressure (IOP) in patients without ocular disease is not fully understood.
• Elevated IOP can pose risks to ocular health.

Purpose of the Study:

• To investigate the effect of sTBURG positioning during RAL on IOP.
• To compare IOP changes in patients undergoing RAL with sTBURG versus traditional surgical positions.
• To assess potential ocular risks associated with sTBURG in patients with healthy eyes.

Main Methods:

• Prospective cohort study comparing 18 patients in RAL with sTBURG to 21 controls in horizontal open or laparoscopic surgery.
• Ophthalmologic examinations preoperatively and 1 month postoperatively, including visual acuity, IOP, visual fields, and OCT.
• Intraoperative IOP measurements at discrete time-points.

Main Results:

• Baseline IOP was similar across all groups.
• A significant IOP plateau of 29.9 mm Hg was observed during RAL with sTBURG.
• No significant changes in OCT RNFL thickness or visual field parameters were detected.

Conclusions:

• Robotic surgery utilizing sTBURG positioning leads to significant IOP elevations in patients with healthy eyes.
• A multidisciplinary approach is recommended to evaluate risks for patients with known ocular disease undergoing these procedures.
• Further investigation into long-term ocular effects and risk mitigation strategies is warranted.