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Olof Hallböök1, Rune Sjödahl2

  • 1Kirurgiska kliniken - Linköping, Sweden - Kirurgiska kliniken Linköping, Sweden.

Lakartidningen
|January 17, 2018
PubMed
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Prolonged Trendelenburg position during pelvic surgery can cause vision loss from optic nerve injury. This review explains the causes and prevention strategies for this rare but serious complication.

Area of Science:

  • Ophthalmology
  • Surgical Complications
  • Neurology

Background:

  • Postoperative vision loss, specifically acute ischemic optic neuropathy, is a rare but severe complication.
  • Pelvic surgeries, particularly robot-assisted procedures, carry a risk associated with patient positioning.

Purpose of the Study:

  • To elucidate the pathophysiological mechanisms behind optic nerve injury in the context of Trendelenburg positioning.
  • To provide practical strategies for preventing vision loss during and after pelvic surgery.

Main Methods:

  • Literature review focusing on risk factors and mechanisms of ischemic optic neuropathy.
  • Analysis of reported cases and physiological studies related to Trendelenburg position and intraabdominal pressure.

Main Results:

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  • Steep Trendelenburg position, elevated intraabdominal pressure, and extended operative duration are identified as key risk factors.
  • The pathophysiology involves compromised optic nerve perfusion due to these factors.

Conclusions:

  • Awareness of these risk factors is crucial for preventing optic nerve injury.
  • Implementing preventative measures during robot-assisted pelvic surgery can mitigate the risk of postoperative vision loss.