Intraocular pressure during robotic-assisted laparoscopic prostatectomy: a prospective observational study

Area of Science:

• Ophthalmology
• Urology
• Surgical Anesthesia

Background:

• Previous studies noted intraocular pressure (IOP) changes during robotic-assisted laparoscopic prostatectomy.
• However, the specific time course and peak IOP changes were not well-defined.

Purpose of the Study:

• To quantify IOP changes over time in patients undergoing robotic-assisted laparoscopic prostatectomy.
• To determine the timing of the largest IOP increase during the steep Trendelenburg position.

Main Methods:

• Twenty-one male patients were enrolled in the study.
• IOP was measured at five time points: pre-anesthesia (T0), and 30 (T1), 90 (T2), 150 minutes (T3) in Trendelenburg, and 30 minutes post-repositioning (T4).
• Statistical analysis included repeated-measures ANOVA and mixed-effects multivariate regression.

Main Results:

• Mean IOP increased significantly from baseline (18.3 mmHg) at T1 (23.6 mmHg), T2 (25.1 mmHg), and T3 (25.3 mmHg) (p < 0.0001).
• The peak IOP increase was approximately 7 mmHg above baseline around 90 minutes.
• No significant difference was observed between T2 and T3, and IOP returned to baseline at T4 (18.1 mmHg).

Conclusions:

• The steep Trendelenburg position during robotic-assisted laparoscopic prostatectomy demonstrably increases intraocular pressure.
• The IOP elevation is moderate and peaks around 90 minutes into the procedure.
• Intraocular pressure normalizes within 30 minutes after returning to the supine position.