Impact of an intraoperative Trendelenburg break on perioperative outcomes during robot-assisted radical prostatectomy

The objective of this study is to assess the effect of an intraoperative steep Trendelenburg break during robot-assisted laparoscopic radical prostatectomy (RALP) on perioperative outcomes and positioning-related complications. A retrospective chart review was performed of patients who underwent RALP at our institution. Patients who underwent a steep Trendelenburg break (T-break) were identified and compared to those who did not undergo a steep Trendelenburg break (No T-break) via univariate analysis using the Kruskal-Wallis test for continuous variables and χ2 test for categorical variables. Binomial logistic regression was used to model 30-day complications as a function of time. Multiple linear regression was used to determine factors influencing time in steep Trendelenburg. 247 RALP were included in the study, of which 13 underwent a T-break. No differences were observed in patient demographics or pathologic characteristics. Patients undergoing a T-break were more likely to have increased operating time (p = 0.0009) and increased time spent in steep Trendelenburg (p = 0.0023). No significant differences in major perioperative outcomes or 30-day complication rates were observed between groups. One episode of conjunctivitis was observed in the No T-break cohort. Logistic regression analysis found no association between duration of steep Trendelenburg and 30-day complication rate. Positioning-related complications following RALP were rare. In this retrospective study, adoption of an intraoperative T-break was not associated with differences in 30-day complication rates. Further studies are needed to better define the role of this intervention in urologic pelvic surgery.