Haemodynamics and cardiac function during robotic-assisted laparoscopic prostatectomy in steep Trendelenburg position

Robot-assisted laparoscopic prostatectomy (RALP) is a minimally invasive technique for the treatment of prostate cancer. RALP requires the patient to be placed in the steep Trendelenburg position, along with pneumoperitoneum, which may increase the risk of postoperative pulmonary complications (PPCs). This large single-center retrospective study evaluated the incidence and risk factors of PPCs in 2208 patients who underwent RALP between 2014 and 2017. Patients were divided into those with (PPC group) and without (non-PPC group) PPCs. Postoperative outcomes were evaluated, and univariate and multivariate logistic regression analyses were performed to assess risk factors of PPCs. PPCs occurred in 682 patients (30.9%). Risk factors of PPCs included age (odds ratio [OR], 1.023; p = 0.001), body mass index (OR, 1.061; p = 0.001), hypoalbuminemia (OR, 1.653; p = 0.008), and positive end-expiratory pressure (PEEP) application (OR, 0.283; p < 0.001). The incidence of postoperative complications, rate of intensive care unit (ICU) admission, and duration of ICU stay were significantly greater in the PPC group than in the non-PPC group. In conclusion, the incidence of PPCs in patients who underwent RALP under pneumoperitoneum in the steep Trendelenburg position was 30.9%. Factors associated with PPCs included older age, higher body mass index, hypoalbuminemia, and lack of PEEP.

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Cardiac Function and Hemodynamic Changes during Minimally Invasive Hysterectomy with Pneumoperitoneum and Steep Trendelenburg Position for Patients with Endometrial Cancer Who Are Obese

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2020.10.005 ◽

2020 ◽

Author(s):

Ido Laskov ◽

Sharon Alpern ◽

Ilai Ronel ◽

Roy Segal ◽

Ofra Zindel ◽

...

Keyword(s):

Endometrial Cancer ◽

Minimally Invasive ◽

Cardiac Function ◽

Hemodynamic Changes ◽

Trendelenburg Position ◽

Steep Trendelenburg Position ◽

Minimally Invasive Hysterectomy

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Ocular blood flow in steep Trendelenburg positioning during robotic-assisted radical prostatectomy

European Journal of Ophthalmology ◽

10.5301/ejo.5001061 ◽

2017 ◽

Vol 28 (3) ◽

pp. 333-338 ◽

Cited By ~ 2

Author(s):

Christian L. Demasi ◽

Francesco Porpiglia ◽

Augusto Tempia ◽

Savino D’Amelio

Keyword(s):

Blood Flow ◽

Radical Prostatectomy ◽

Perfusion Pressure ◽

Ocular Blood Flow ◽

Ocular Perfusion Pressure ◽

Trendelenburg Position ◽

Robotic Assisted ◽

Ocular Perfusion ◽

Steep Trendelenburg Position ◽

Pulsatile Ocular Blood Flow

Purpose: Several ischemic optic neuropathies that occurred during robotic-assisted laparoscopic radical prostatectomy (RALRP) have been reported to be due to the Trendelenburg position, which lowers ocular perfusion pressure (OPP). We examined changes in pulsatile ocular blood flow (POBF) and its correlation with OPP during RALRP in the steep Trendelenburg position. Methods: Pulsatile ocular blood flow and intraocular pressure (IOP) were measured in 50 patients by the OBF Langham System 5 times during RALRP. The mean arterial blood pressure (MAP), heart rate, plateau airway pressure, and end-tidal CO2 (EtCO2) at each time point were recorded. Ocular perfusion pressure was calculated from simultaneous IOP and MAP measurements. Results: Pulsatile ocular blood flow was 15.53 ± 3.32 µL/s at T0, 18.99 ± 4.95 µL/s at T1, 10.04 ± 3.24 µL/s at T2, 11.45 ± 3.02 µL/s at T3, and 15.07 ± 3.81 µL/s at T4. Ocular perfusion pressure was 70.15 ± 5.98 mm Hg at T0, 64.21 ± 6.77 mm Hg at T1, 57.71 ± 7.07 mm Hg at T2, 51.73 ± 11.58 mm Hg at T3, and 64.21 ± 12.37 mm Hg at T4. Repeated-measures analysis of variance on POBF and OPP was significant (p>0.05). This difference disappeared when the correlation between MAP and POBF, EtCO2 and POBF, and EtCO2 and OPP were considered, while correlation between MAP and OPP confirmed the difference. The regression analysis between POBF and OPP showed a statistically significant difference at T0 and T3 (r = 0.047, p = 0.031 and r = 0.096, p = 0.002, respectively). Conclusions: Pulsatile ocular blood flow and OPP reached the lowest level at the end of surgery.

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Intraoperative changes in whole-blood viscosity in patients undergoing robot-assisted laparoscopic prostatectomy in the steep Trendelenburg position with pneumoperitoneum: a prospective nonrandomized observational cohort study

BMC Anesthesiology ◽

10.1186/s12871-019-0919-z ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Jung-Woo Shim ◽

Hyun Kyung Moon ◽

Yong Hyun Park ◽

Misun Park ◽

Jaesik Park ◽

...

Keyword(s):

Shear Rate ◽

Supine Position ◽

Blood Viscosity ◽

Whole Blood ◽

Hematocrit Level ◽

Robot Assisted ◽

Trendelenburg Position ◽

Whole Blood Viscosity ◽

Laparoscopic Prostatectomy ◽

Steep Trendelenburg Position

Abstract Background The aim of this study was to investigate the effect of the steep Trendelenburg position (STP) with pneumoperitoneum on whole-blood viscosity (WBV) in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). The study also analyzed the associations of clinical patient-specific and time-dependent variables with WBV and recorded postoperative outcomes. Methods Fifty-eight adult male patients (ASA physical status of I or II) undergoing elective RALP were prospectively analyzed in this study. WBV was intraoperatively measured three times: at the beginning of surgery in the supine position without pneumoperitoneum; after 30 min in the STP with pneumoperitoneum; and at the end of surgery in the supine position without pneumoperitoneum. The WBV at a high shear rate (300 s− 1) was recorded as systolic blood viscosity (SBV) and that at a low shear rate (5 s− 1) was recorded as diastolic blood viscosity (DBV). Systolic blood hyperviscosity was defined as > 13.0 cP at 300 s− 1 and diastolic blood hyperviscosity was defined as > 4.1 cP at 5 s− 1. Results The WBV and incidences of systolic and diastolic blood hyperviscosity significantly increased from the supine position without pneumoperitoneum to the STP with pneumoperitoneum. When RALP was performed in the STP with pneumoperitoneum, 12 patients (27.3%) who had normal SBV at the beginning of surgery and 11 patients (26.8%) who had normal DBV at the beginning of surgery developed new systolic and diastolic blood hyperviscosity, respectively. The degree of increase in WBV after positioning with the STP and pneumoperitoneum was higher in the patients with hyperviscosity than in those without hyperviscosity at the beginning of surgery. Higher preoperative body mass index (BMI) and hematocrit level were associated with the development of both systolic and diastolic blood hyperviscosity in the STP with pneumoperitoneum. All patients were postoperatively discharged without fatal complications. Conclusions Changes in surgical position may influence WBV, and higher preoperative BMI and hematocrit level are independent factors associated with the risk of hyperviscosity during RALP in the STP with pneumoperitoneum. Trial registration Clinical Research Information Service, Republic of Korea, approval number: KCT0003295 on October 25, 2018.

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