title: Blinded measure of Trendelenburg angle in pelvic robotic surgery.
abstract: OBJECTIVE
  To estimate the Trendelenburg angle needed to perform robotic gynecologic surgical procedures.
  
  
  METHODS
  Cross-sectional study (Canadian Task Force classification III).
  
  
  METHODS
  Community hospital.
  
  
  METHODS
  All women undergoing gynecologic pelvic surgery using the da Vinci surgical robot at a single institution between December 2010 and April 2011.
  
  
  METHODS
  The primary surgeon determined the Trendelenburg angle needed for adequate visualization to perform surgery defined as small bowel and sigmoid colon displaced out of the surgical field.
  
  
  RESULTS
  The primary outcome, measured in blinded fashion, was the degree of Trendelenburg positioning needed to complete the surgical procedure robotically. Secondary data collected included body mass index, type of surgery performed, maximum end-tidal CO(2), and maximum peak inspiratory pressure. Sixteen surgeons performed a total of 104 robotic gynecologic pelvic surgeries during the study. Data were available for 86 cases. The mean Trendelenburg angle used was 28.0 degrees (95% confidence interval, 26.9-29.1). This was significantly less than the 40 degrees (p < .001) commonly recommended. The Trendelenburg angle used did not correlate with body mass index (r = -0.2; p = .13) or type of surgery performed (p = .41). Neither the maximum end-tidal CO(2) or maximum peak inspiratory pressure was influenced by the Trendelenburg angle used when adjusted for age and body mass index.
  
  
  CONCLUSIONS
  A mean Trendelenburg angle of 28.0 degrees was adequate to complete most gynecologic robotic surgical procedures when compared with historical control angle of 40 degrees.
authors.affiliation: Legacy Health System, Graduate Medical Education, Portland, Oregon 97210, USA. cgould@lhs.org
authors.forename: Claire
authors.initials: C
authors.lastname: Gould
authors.forename: Thomas
authors.initials: T
authors.lastname: Cull
authors.forename: Ying Xing
authors.initials: YX
authors.lastname: Wu
authors.forename: Blake
authors.initials: B
authors.lastname: Osmundsen
mesh_terms: D000328:Adult; D000368:Aged; D000403:Airway Resistance; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005260:Female; D018475:Head-Down Tilt; D006801:Humans; D007044:Hysterectomy; D001239:Inhalation; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D056888:Patient Positioning; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011659:Pulmonary Gas Exchange; D012371:Robotics; D016037:Single-Blind Method