Robotic-assisted interaortocaval dissection of an extra-adrenal paraganglioma in supine position via a trans-peritoneal approach

This report describes the first case of uninterrupted peritoneal dialysis (PD) after robotic-assisted laparoscopic hysterectomy. Frequent low-volume PD exchanges in a supine position to minimize intra-abdominal pressure starting on post-operative day 3 successfully provided adequate clearance and ultrafiltration. The patient did not encounter any metabolic or wound complications. Pre-admission PD prescription was resumed on post-operative day 14. Interim hemodialysis was not needed.

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Retinal Nerve Fiber Layer Thickness Progression after Robotic-Assisted Laparoscopic Radical Prostatectomy in Glaucoma Patients

Journal of Ophthalmology ◽

10.1155/2019/6576140 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Kazuyuki Hirooka ◽

Kaori Ukegawa ◽

Eri Nitta ◽

Nobufumi Ueda ◽

Yushi Hayashida ◽

...

Keyword(s):

Visual Field ◽

Radical Prostatectomy ◽

Nerve Fiber ◽

Retinal Nerve Fiber Layer ◽

Supine Position ◽

Laparoscopic Radical Prostatectomy ◽

Fiber Layer ◽

Robotic Assisted ◽

Nerve Fiber Layer ◽

Rnfl Thickness

Purpose. To investigate the effect of the steep Trendelenburg position surgical procedure on the retinal structure and function during robotic-assisted laparoscopic radical prostatectomy (RALP) in glaucoma patients. Methods. At 1 month and 1 day before and at 1 and 2 months after the RALP operation, 10 glaucoma patients underwent standard automated perimetry and optical coherence tomography. After placing patients in a supine position, intraocular pressure (IOP) was measured at 5 min after intubation under general anesthesia (T1), at 5 discrete time points (5, 30, 60, 120, and 180 min; T2-6) and at 5 min after returning to a horizontal supine position (T7). The Guided Progression Analysis software program was used to assess serial retinal nerve fiber layer (RNFL) thicknesses and visual field progression. Results. Eight additional patients were newly diagnosed in addition to the two previous glaucoma patients. Average IOP (mmHg) at each time point was as follows: T1 = 11.2 ± 3.8, T2 = 19.0 ± 4.4, T3 = 23.3 ± 6.3, T4 = 25.1 ± 4.3, T5 = 25.5 ± 5.1, T6 = 28.3 ± 4.8, and T7 = 22.6 ± 5.4. IOP significantly increased during RALP. RNFL thickness progressed in two eyes of two patients after the surgery, even though there was no progression of the visual field. Conclusions. Two eyes of two patients exhibited significant RNFL thickness progression. Since an increased IOP during the surgery was the probable cause of the changes, ophthalmologic examinations should be performed before and after RALP, especially in glaucoma patients.

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The Effect of Steep Trendelenburg Positioning on Retinal Structure and Function during Robotic-Assisted Laparoscopic Procedures

Journal of Ophthalmology ◽

10.1155/2018/1027397 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Kazuyuki Hirooka ◽

Kaori Ukegawa ◽

Eri Nitta ◽

Nobufumi Ueda ◽

Yushi Hayashida ◽

...

Keyword(s):

Visual Field ◽

Supine Position ◽

Structure And Function ◽

Automated Perimetry ◽

Robotic Assisted ◽

Visual Field Progression ◽

Rnfl Thickness ◽

Steep Trendelenburg Position ◽

Retinal Structure ◽

And Function

Purpose. Robotic-assisted laparoscopic radical prostatectomy (RALP) has become a standard treatment choice for localized prostate cancer. RALP requires a steep Trendelenburg position, which leads to a significant increase in intraocular pressure (IOP). This study evaluated the effect on the retinal structure and function in patients undergoing RALP. Methods. Standard automated perimetry (SAP) and optical coherence tomography (OCT) were performed in 20 males scheduled for RALP at 1 month and 1 day before the operation and at 1 and 3 months after the operation. IOP measurements were made in the supine position at 5 min after intubation under general anesthesia (T1), at 6 discrete time points (5, 30, 60, 120, 180, and 240 min; T2-7), and at 5 min after returning to a horizontal supine position (T8). Serial retinal nerve fiber layer (RNFL) thicknesses and visual field progression were assessed using the guided progression analysis software program. RNFL thickness progression and visual field progression were evaluated by event analysis. Results. Average IOP (mmHg) for each time point was as follows: T1 = 12.3 ± 2.6, T2 = 20.4 ± 4.2, T3 = 23.3 ± 3.8, T4 = 24.0 ± 3.2, T5 = 24.3 ± 3.4, T6 = 27.1 ± 7.2, T7 = 29.8 ± 8.7, and T8 = 20.1 ± 4.4. During RALP, IOP significantly increased. There was no progression of the visual field and RNFL thickness after surgery or any other ocular complications found. Conclusions. Although IOP significantly increased during RALP, there were no significant changes in the retinal structure and function between the pre- and postoperation observations.

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Pronounced haemodynamic changes during and after robotic-assisted laparoscopic prostatectomy: a prospective observational study

BMJ Open ◽

10.1136/bmjopen-2020-038045 ◽

2020 ◽

Vol 10 (10) ◽

pp. e038045

Author(s):

Michael T Pawlik ◽

Christopher Prasser ◽

Florian Zeman ◽

Marion Harth ◽

Maximilian Burger ◽

...

Keyword(s):

Heart Rate ◽

Observational Study ◽

Supine Position ◽

Prospective Observational Study ◽

Volume Index ◽

Robotic Assisted ◽

Laparoscopic Prostatectomy ◽

Haemodynamic Parameters ◽

Steep Trendelenburg Position ◽

Haemodynamic Changes

ObjectivesRobotic-assisted laparoscopic prostatectomy (RALP) is typically conducted in steep Trendelenburg position (STP). This study investigated the influence of permanent 45° STP and capnoperitoneum on haemodynamic parameters during and after RALP.DesignProspective observational study.SettingHaemodynamic changes were recorded with transpulmonary thermodilution and pulse contour analysis in men undergoing RALP under standardised anaesthesia.ParticipantsInformed consent was obtained from 51 patients scheduled for elective RALP in a University Medical Centre in Germany.InterventionsHeart rate, mean arterial pressure, central venous pressure (CVP), Cardiac Index (CI), systemic vascular resistance (SVR), Global End-Diastolic Volume Index (GEDI), global ejection fraction (GEF), Cardiac Power Index (CPI) and stroke volume variation (SVV) were recorded at six time points: 20 min after induction of anaesthesia (T1), after insufflation of capnoperitoneum in supine position (T2), after 30 min in STP (T3), when controlling Santorini’s plexus in STP (T4), before awakening in supine position (T5) and after 45 min in the recovery room (T6). Adverse cardiac events were registered intraoperatively and postoperatively.ResultsAll haemodynamic parameters were significantly changed by capnoperitoneum and STP during RALP and partly normalised at T6. CI, GEF and CPI were highest at T6 (CI: 3.9 vs 2.2 L/min/m²; GEF: 26 vs 22%; CPI: 0.80 vs 0.39 W/m²; p<0.001). CVP was highest at T4 (31 vs 7 mm Hg, p<0.001) and GEDI at T6 (819 vs 724 mL/m², p=0.005). Mean SVR initially increased (T2) but had decreased by 24% at T6 (p<0.001). SVV was highest at T5 (12 vs 9%, p<0.001). Two of the patients developed cardiac arrhythmia during RALP and one patient suffered postoperative cardiac ischaemia.ConclusionsRALP led to pronounced perioperative haemodynamic changes. The combination of increased cardiac contractility and heart rate reflects a hyperdynamic situation during and after RALP. Anaesthesiologists should be aware of unnoticed pre-existing heart failure to worsen during STP in patients undergoing RALP.

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