Category: Laparoscopic/ Robotic: Prostate

MP15-20 - Comparison of intraocular pressure during robot-assisted laparoscopic prostatectomy between standard 25° and gentle 15° Trendelenburg position. A prospective study

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

Robot-assisted laparoscopic prostatectomy (RALP) requires a steep Trendelenburg position, which may result in increased intraocular pressure (IOP). Recent studies have reported that high IOP can cause visual loss by ischemic optic neuropathy. We aimed to compare the impacts of 25° and 15° Trendelenburg positions (TP) on IOP changes during RALP.


Methods :

After institute ethics committee approval and written informed consent, 31 patients with prostate cancer who received RALP were included in this non-randomized prospective study. Twenty-six patients received RALP in standard 25° TP using intraperitoneal approach (IA) and five patients received RALP in gentle 15° TP using extraperitoneal approach (EA). In addition to the perioperative parameters, IOP was measured at 9 discrete time points as follows: at the start of operation (S1), at the initiation of pneumoperitoneum (S2), at the start of TP (H1), 1 h after TP (H2), 2 h after TP (H3), when resection of Santorini’s plexus (H4), before returning of the supine position (SP) (H5), 5 min after SP (S3), 10 min after SP (S4). The IOP was compared between S1 and other time points and also compared between IA and EA.


Results :

IOP significantly increased at H1-H5 but immediately decreased after returning to the supine position in both groups. On the other hand, IOP of EA at H1-5 were significantly lower than those of TA. Furthermore, IOP change between S1 and H5 correlated significantly with age (r = −0.26), time of TP (r = 0.22) and angle of TP (25° vs 15°, r = −0.51). Meanwhile, none of the patients complained of visual impairment in the present study.


Conclusions : RALP in gentle 15° TP significantly attenuated the elevation of IOP during head down position in comparison with RALP in 25° TP. Although further evaluation is required in patient with glaucoma, RALP in gentle 15° TP might expand indication for RALP to the patient with glaucoma.

Yasukiyo Murakami

Clinical Fellow
Department of Urology, Kitasato University School of Medicine
Sagamihara, Kanagawa, Japan

Yasukiyo Murakami,a Fellow,
Department of Urology ,KITASATO University School of Medicine

Ken-ichi Tabata

Assistant professor
Department of Urology, Kitasato University School of Medicine
Sagamihara, Kanagawa, Japan

Hideyasu Tsumura

Department of Urology, Kitasato University School of Medicine
Sagamihara, Kanagawa, Japan

Takahiro Hirayama

Clinical Fellow
Department of Urology, Kitasato University School of Medicine
Sagamihara, Kanagawa, Japan

Takahiro HIRAYAMA, MD

Professional Experience
Current
Fellow
Dept. of Urology, Kitasato University Hospital (Sagamihara-city, Kanagawa ,Japan) Apr,2013- present
Previous
Resident
Dept. of Urology, Kitasato University Hospital (Sagamihara-city, Kanagawa, Japan) Oct,2012- Mar.2013
Postdoctoral Fellow
Dept. of Genitourinary, MD Anderson Cancer Center (Houston, TX, USA) Jun,2010- Sep,2012
Resident
Dept. of Urology, Kitasato University Hospital (Sagamihara-city, Kanagawa, Japan) May,2002- Mar,2010

Education and Training
The Japanese Urological Association (Bunkyo-ku,Tokyo,Japan), Board Certified Instructor and Specialist of The Japanese Urological Association
The Japanese Board of Cancer Therapy (Shinjuku-ku,Tokyo,Japan), Board Certified physician of Japanese Board of Cancer Therapy
The Japan Society of Transplantation (Shinjuku-ku,Tokyo,Japan), Board Certified transplant physician by The Japan Society of Transplantation
The Japan Society of Endoscopic surgery (Chiyoda-ku,Tokyo,Japan),Endoscopic surgical skill qualification system: qualified urologist
Kitasato University Graduate School of Medicine (Sagamihara-city, Kanagawa, Japan), Ph.D in Medicine
Kitasato University School of Medicine (Sagamihara-city, Kanagawa ,Japan), M.D.

Kazumasa Matsumoto

Department of Urology, Kitasato University School of Medicine
Sagamihara, Kanagawa, Japan

Tamie Takenami

Department of Anesthesiology, Kitasato University School of Medicine
Sagamihara, Kanagawa, Japan

Tetstuya Ikeda

Department of Ophthalmology, Kitasato University School of Medicine
Sagamihara, Kanagawa, Japan

Masatsugu Iwamura

Professor
Department of Urology, Kitasato University School of Medicine
Sagamihara, Kanagawa, Japan