Intraocular pressure and steep trendelenburg during minimally invasive gynecologic surgery

Is there a risk?

Mostafa A. Borahay, Pooja Patel, Teresa M. Walsh, Vijay Tarnal, Aristides Koutrouvelis, Gianmarco Vizzeri, Kristofer Jennings, Sean Jerig, Gokhan Kilic

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Study Objective: Steep Trendelenburg position is frequently used during gynecologic minimally invasive surgery (MIS). However, little attention has been given to the potential impact of this nonphysiologic positioning on patients, specifically intraocular pressure (IOP). The purpose of our study was to evaluate IOP changes during laparoscopic or robotic hysterectomy conducted in the steep Trendelenburg position. Design: Prospective cohort study (Canadian Task Force classification II-2). Setting: John Sealy Hospital at the University of Texas Medical Branch, Galveston, TX. Patients: Female patients with no history of ocular pathology who underwent elective robotic or laparoscopic hysterectomy. Interventions: The anesthesia protocol was standardized for all study patients. IOP and mean arterial pressure (MAP) were obtained before anesthesia, after general anesthesia and intubation were achieved, after 1 hour of steep Trendelenburg positioning, after 2 hours of steep Trendelenburg positioning, and after the patient was returned to the supine position. Ocular perfusion pressure (OPP) was calculated using the following equation: OPP = MAP - IOP. Main Results: A total of 10 patients were included in this prospective study. A significant increase in IOP from baseline was observed after 1 hour and 2 hours of steep Trendelenburg positioning (p = .005 and .002, respectively). There was a statistically significant trend of increasing the IOP from baseline to the second hour of steep Trendelenburg positioning (p < .001). The IOP remained significantly elevated once the patient was returned to the supine position when compared with the baseline IOP (p = .006). OPP significantly decreased from baseline after 2 hours of steep Trendelenburg positioning (p = .03). Conclusions: IOP increases significantly when patients are placed in the steep Trendelenburg position. Although further studies are needed to better characterize this process, given the aging population of our MIS patients in whom risk for glaucoma is significant, preoperative ocular health assessment should be considered in certain cases.

Original languageEnglish (US)
Pages (from-to)819-824
Number of pages6
JournalJournal of Minimally Invasive Gynecology
Volume20
Issue number6
DOIs
StatePublished - 2013

Fingerprint

Gynecologic Surgical Procedures
Minimally Invasive Surgical Procedures
Intraocular Pressure
Head-Down Tilt
Patient Positioning
Perfusion
Supine Position
Robotics
Hysterectomy
Pressure
Arterial Pressure
Anesthesia
Prospective Studies
Advisory Committees
Intubation
Glaucoma
General Anesthesia
Cohort Studies
Pathology

Keywords

  • Intraocular pressure
  • Robotic surgery
  • Trendelenburg

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

@article{be576be0086f42049e909f132d7f550d,
title = "Intraocular pressure and steep trendelenburg during minimally invasive gynecologic surgery: Is there a risk?",
abstract = "Study Objective: Steep Trendelenburg position is frequently used during gynecologic minimally invasive surgery (MIS). However, little attention has been given to the potential impact of this nonphysiologic positioning on patients, specifically intraocular pressure (IOP). The purpose of our study was to evaluate IOP changes during laparoscopic or robotic hysterectomy conducted in the steep Trendelenburg position. Design: Prospective cohort study (Canadian Task Force classification II-2). Setting: John Sealy Hospital at the University of Texas Medical Branch, Galveston, TX. Patients: Female patients with no history of ocular pathology who underwent elective robotic or laparoscopic hysterectomy. Interventions: The anesthesia protocol was standardized for all study patients. IOP and mean arterial pressure (MAP) were obtained before anesthesia, after general anesthesia and intubation were achieved, after 1 hour of steep Trendelenburg positioning, after 2 hours of steep Trendelenburg positioning, and after the patient was returned to the supine position. Ocular perfusion pressure (OPP) was calculated using the following equation: OPP = MAP - IOP. Main Results: A total of 10 patients were included in this prospective study. A significant increase in IOP from baseline was observed after 1 hour and 2 hours of steep Trendelenburg positioning (p = .005 and .002, respectively). There was a statistically significant trend of increasing the IOP from baseline to the second hour of steep Trendelenburg positioning (p < .001). The IOP remained significantly elevated once the patient was returned to the supine position when compared with the baseline IOP (p = .006). OPP significantly decreased from baseline after 2 hours of steep Trendelenburg positioning (p = .03). Conclusions: IOP increases significantly when patients are placed in the steep Trendelenburg position. Although further studies are needed to better characterize this process, given the aging population of our MIS patients in whom risk for glaucoma is significant, preoperative ocular health assessment should be considered in certain cases.",
keywords = "Intraocular pressure, Robotic surgery, Trendelenburg",
author = "Borahay, {Mostafa A.} and Pooja Patel and Walsh, {Teresa M.} and Vijay Tarnal and Aristides Koutrouvelis and Gianmarco Vizzeri and Kristofer Jennings and Sean Jerig and Gokhan Kilic",
year = "2013",
doi = "10.1016/j.jmig.2013.05.005",
language = "English (US)",
volume = "20",
pages = "819--824",
journal = "Journal of Minimally Invasive Gynecology",
issn = "1553-4650",
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TY - JOUR

T1 - Intraocular pressure and steep trendelenburg during minimally invasive gynecologic surgery

T2 - Is there a risk?

AU - Borahay, Mostafa A.

AU - Patel, Pooja

AU - Walsh, Teresa M.

AU - Tarnal, Vijay

AU - Koutrouvelis, Aristides

AU - Vizzeri, Gianmarco

AU - Jennings, Kristofer

AU - Jerig, Sean

AU - Kilic, Gokhan

PY - 2013

Y1 - 2013

N2 - Study Objective: Steep Trendelenburg position is frequently used during gynecologic minimally invasive surgery (MIS). However, little attention has been given to the potential impact of this nonphysiologic positioning on patients, specifically intraocular pressure (IOP). The purpose of our study was to evaluate IOP changes during laparoscopic or robotic hysterectomy conducted in the steep Trendelenburg position. Design: Prospective cohort study (Canadian Task Force classification II-2). Setting: John Sealy Hospital at the University of Texas Medical Branch, Galveston, TX. Patients: Female patients with no history of ocular pathology who underwent elective robotic or laparoscopic hysterectomy. Interventions: The anesthesia protocol was standardized for all study patients. IOP and mean arterial pressure (MAP) were obtained before anesthesia, after general anesthesia and intubation were achieved, after 1 hour of steep Trendelenburg positioning, after 2 hours of steep Trendelenburg positioning, and after the patient was returned to the supine position. Ocular perfusion pressure (OPP) was calculated using the following equation: OPP = MAP - IOP. Main Results: A total of 10 patients were included in this prospective study. A significant increase in IOP from baseline was observed after 1 hour and 2 hours of steep Trendelenburg positioning (p = .005 and .002, respectively). There was a statistically significant trend of increasing the IOP from baseline to the second hour of steep Trendelenburg positioning (p < .001). The IOP remained significantly elevated once the patient was returned to the supine position when compared with the baseline IOP (p = .006). OPP significantly decreased from baseline after 2 hours of steep Trendelenburg positioning (p = .03). Conclusions: IOP increases significantly when patients are placed in the steep Trendelenburg position. Although further studies are needed to better characterize this process, given the aging population of our MIS patients in whom risk for glaucoma is significant, preoperative ocular health assessment should be considered in certain cases.

AB - Study Objective: Steep Trendelenburg position is frequently used during gynecologic minimally invasive surgery (MIS). However, little attention has been given to the potential impact of this nonphysiologic positioning on patients, specifically intraocular pressure (IOP). The purpose of our study was to evaluate IOP changes during laparoscopic or robotic hysterectomy conducted in the steep Trendelenburg position. Design: Prospective cohort study (Canadian Task Force classification II-2). Setting: John Sealy Hospital at the University of Texas Medical Branch, Galveston, TX. Patients: Female patients with no history of ocular pathology who underwent elective robotic or laparoscopic hysterectomy. Interventions: The anesthesia protocol was standardized for all study patients. IOP and mean arterial pressure (MAP) were obtained before anesthesia, after general anesthesia and intubation were achieved, after 1 hour of steep Trendelenburg positioning, after 2 hours of steep Trendelenburg positioning, and after the patient was returned to the supine position. Ocular perfusion pressure (OPP) was calculated using the following equation: OPP = MAP - IOP. Main Results: A total of 10 patients were included in this prospective study. A significant increase in IOP from baseline was observed after 1 hour and 2 hours of steep Trendelenburg positioning (p = .005 and .002, respectively). There was a statistically significant trend of increasing the IOP from baseline to the second hour of steep Trendelenburg positioning (p < .001). The IOP remained significantly elevated once the patient was returned to the supine position when compared with the baseline IOP (p = .006). OPP significantly decreased from baseline after 2 hours of steep Trendelenburg positioning (p = .03). Conclusions: IOP increases significantly when patients are placed in the steep Trendelenburg position. Although further studies are needed to better characterize this process, given the aging population of our MIS patients in whom risk for glaucoma is significant, preoperative ocular health assessment should be considered in certain cases.

KW - Intraocular pressure

KW - Robotic surgery

KW - Trendelenburg

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