title: Intraocular Pressure During Robotic-assisted Laparoscopic Procedures Utilizing Steep Trendelenburg Positioning.
abstract: OBJECTIVE
  To determine the effect of steep Trendelenburg (sTBURG) surgical positioning on intraocular pressure (IOP) during robotic-assisted laparoscopy (RAL) in subjects without previously identified ocular disease.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Eighteen patients undergoing RAL with sTBURG and 21 controls undergoing open and laparoscopic cases in horizontal positioning.
  
  
  METHODS
  Research data derived from an approved Naval Medical Center, San Diego, CA, IRB protocol. A study group undergoing RAL utilizing sTBURG (group 1) was compared with a control group undergoing open surgery in the horizontal position (group 2), and laparoscopic cases in the horizontal position (group 3). An ophthalmologic examination including Snellen visual acuity, IOP, Humphrey Visual Field (HVF) 24-2 with standard Swedish Interactive Thresholding Algorithm, time domain optical coherence tomography (OCT), retinal nerve fiber layer (RNFL) analysis, pachymetry, and dilated fundus examination was conducted preoperatively and at 1 month postoperatively. IOP was measured intraoperatively at discrete time-points.
  
  
  METHODS
  IOP values, change in OCT RNFL thickness, HVF mean deviation, and HVF pattern standard deviation.
  
  
  RESULTS
  Baseline IOP (mm Hg) was similar, 13.7±3.2 for group 1 versus 15.3±3.2 for group 2 and 14.1±2.4 for group 3 (P=0.55). The IOP plateau from 60 minutes until case conclusion occurred at 29.9 mm Hg (95% confidence interval, 27.4-32.5), 19.9 mm Hg (95% confidence interval, 17.6-22.3), and 22.8 mm Hg (95% confidence interval, 20.2-25.4) for group 1, group 2, and group 3, respectively. There were no significant changes in OCT RNFL thickness, HVF mean deviation, and HVF pattern standard deviation.
  
  
  CONCLUSIONS
  Significant elevations of IOP are experienced during robotic surgery utilizing sTBURG positioning in patients with healthy eyes, and we recommend a multidisciplinary approach in determining potential risk to those with known ocular disease who are candidates for these procedures.
authors.affiliation: Departments of †Urology *Ophthalmology §Anesthesiology, Naval Medical Center San Diego, San Diego, CA ‡Department of Ophthalmology, Naval Medical Center Portsmouth, VA.
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Mondzelewski
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Schmitz
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Christman
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Davis
authors.forename: Eugenio
authors.initials: E
authors.lastname: Lujan
authors.forename: James O
authors.initials: JO
authors.lastname: L'Esperance
authors.forename: Brian K
authors.initials: BK
authors.lastname: Auge
mesh_terms: D000328:Adult; D005260:Female; D018475:Head-Down Tilt / Q000502:physiology*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D011446:Prospective Studies; D065287:Robotic Surgical Procedures; D041623:Tomography, Optical Coherence; D014065:Tonometry, Ocular; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology