Robot-assisted pelvic urologic surgeries: is it feasible to perform under reduced tilt?
- 1 August 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of Robotic Surgery
- Vol. 15 (4), 553-559
- https://doi.org/10.1007/s11701-020-01139-7
Abstract
To evaluate the feasibility and outcomes of performing robot-assisted pelvic surgery at a reduced angle of Trendelenburg position. This was a prospective case-control study of 67 patients in 2:1 ratio. Controls were operated with steep Trendelenburg position of 30 degrees, whereas cases were operated using a graduated method to achieve minimal optimal angle of operating table. Various body habitus parameters, console time, blood loss, rise in mean arterial pressure (MAP) and end-tidal carbon-dioxide (ET-CO2), duration of ileus, postoperative stay and complications were recorded. All demographic profile and body habitus parameters were comparable among two groups except age which was lower in Reduced-Tilt group. Cases were operated at a mean angle of 20.5 +/- 3.1 degrees compared to 30 degrees in control group. Rise in MAP, ET-CO(2)and facial swelling were significantly low in Reduced-Tilt group compared to control. Notably blood loss, duration of ileus, postoperative stay and complications were also low in patients with Reduced Tilt. Various body habitus parameters were analysed with multiple regression analysis to predict minimal angle required for performing surgery with Reduced Tilt. BMI, xiphisterno-umbilical distance, umbilical-pubic-symphyseal distance and subcostal angle were found to predict the same. Robot-assisted pelvic surgeries can be performed in reduced Trendelenburg tilt which is associated with less hemodynamic and respiratory stress, complication rates and early postoperative recovery. BMI, subcostal angle, xiphisterno-umbilical distance and umbilical-pubic-symphyseal distance can predict the feasible angle of tilt.Keywords
This publication has 12 references indexed in Scilit:
- Obesity is associated with decreased lung compliance and hypercapnia during robotic assisted surgeryJournal of Clinical Monitoring and Computing, 2016
- Positioning-Related Complications of Minimally Invasive Radical ProstatectomiesJournal of Endourology, 2014
- Prolonged steep Trendelenburg position: risk of postoperative upper airway obstructionJournal of Robotic Surgery, 2013
- Trendelenburg Position in Gynecologic Robotic-Assisted SurgeryJournal of Minimally Invasive Gynecology, 2012
- Hemodynamic Perturbations During Robot-Assisted Laparoscopic Radical Prostatectomy in 45° Trendelenburg PositionAnesthesia & Analgesia, 2011
- Influence of steep Trendelenburg position and CO2 pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomyBritish Journal of Anaesthesia, 2010
- Pulmonary gas exchange is well preserved during robot assisted surgery in steep Trendelenburg position.2009
- Cardiac function during steep Trendelenburg position and CO2 pneumoperitoneum for robotic‐assisted prostatectomy: a trans‐oesophageal Doppler probe studyInternational Journal of Medical Robotics and Computer Assisted Surgery, 2007
- Anesthesia considerations for robotic-assisted laparoscopic prostatectomy: a review of 1,500 casesJournal of Robotic Surgery, 2007
- Anaesthesia for Robotic-Assisted Radical Prostatectomy: Considerations for Laparoscopy in the Trendelenburg PositionAnaesthesia and Intensive Care, 2007