Angular threshold for intraocular pressure elevation during robot-assisted radical prostatectomy in Trendelenburg...

Area of Science:

• Urology
• Ophthalmology
• Surgical Positioning

Background:

• Robot-assisted radical prostatectomy (RARP) often requires the Trendelenburg position.
• The Trendelenburg position can lead to increased intraocular pressure (IOP), posing ocular risks.
• Optimizing patient positioning is crucial to mitigate these risks during RARP.

Purpose of the Study:

• To determine the critical Trendelenburg angle threshold for IOP elevation during RARP.
• To identify key factors influencing intraocular pressure changes in patients undergoing RARP.
• To develop a predictive model for elevated IOP in RARP patients.

Main Methods:

• Prospective study of 135 patients undergoing RARP with varying Trendelenburg and leg angles.
• Intraoperative IOP measurements at 11 time points.
• Receiver operating characteristic (ROC) curve analysis and univariate/multivariate analyses to identify risk factors and optimal thresholds.

Main Results:

• An optimal Trendelenburg angle threshold of 20.5° was identified; angles ≥20.5° were significantly associated with elevated IOP (p=0.001).
• Diabetes history (p=0.028) and leg angles (≥9.5°) were also identified as independent risk factors for increased IOP.
• A predictive model incorporating Trendelenburg angle, leg angle, mean arterial pressure, and diabetes history showed good discriminative capacity (AUC=0.721).

Conclusions:

• Steeper Trendelenburg positioning (≥20.5°), specific leg angles (≥9.5°), and diabetes are independent risk factors for intraoperative IOP elevation during RARP.
• Individualized patient positioning, using milder angles for high-risk patients, is recommended to reduce ocular complications.
• These findings emphasize the importance of careful patient positioning during RARP to manage ocular risks.