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Abstract #26008 Published in IGR 12-2
Preventing ocular injuries during robotic prostatectomy: A simple technique
Lavery HJ; Samadi DB; Gainsburg DMEuropean Urology, Supplements 2010; 9: 257
Introduction & Objectives: Ocular injuries are a poorly reported, yet significant cause of perioperative morbidity during robotic prostatectomy (RP). The steep Trendelenburg positioning used in the procedure has been demonstrated to increase intraocular pressures to levels of those in patients with glaucoma. Most intraoperative ocular injuries are simple corneal abrasions, but the devastating posterior ischemic optic neuropathy (PION) leading to blindness has been reported during RP. We report a simple technique of reducing such perioperative ocular complications. Material & Methods: From May 2007 to October 2009, 1028 RPs were performed at a single institution by a single surgeon (DBS). A standardized protocol for perioperative anesthetic care of patients undergoing RP was established. End-tidal C02 (ETC02) is tightly controlled, maintained at less than 35 mmHg; total intravenous fluids are restricted to 2000 mL, preferably less than 1500 mL. Initially, tape and ocular lubricant were used to protect the eyes intraoperatively. Intraoperative management of the eyes was changed in October 2007 after several patients were found to have corneal abrasions. A sterile, transparent occlusive dressing (Tegaderm(trademark) 3M, St. Paul, MN) is placed over the eyes upon the loss of the eyelid reflex, without ocular lubricant. Prior to the change in protocol, 214 patients underwent RP; 814 have been performed since. Data on intraoperative fluid resuscitation and ETC02 were available for the first 575 patients. Suspected corneal abrasions were seen by ophthalmology, who confirmed them with fluorescein. Results: In the initial 214 RPs, 5 patients (2.3%) had corneal abrasions. Since instituting the new eye protection method, zero of 814 patients have had a corneal abrasion (p < 0.001). Mean operative time was 117 minutes in the first group, 116 minutes in the second (p=NS). For the first 575 patients, median intraoperative fluid resuscitation was 1600 mL and median ETC02 was 31 mmHg. No episodes of glaucoma, worsened vision or PION occurred at any time point. Conclusions: Urologists should be aware of the ocular complications that can occur during laparoscopic and robotic procedures in steep Trendelenberg. While a minor complication, a corneal abrasion is a preventable cause of perioperative morbidity. The use of a sterile, transparent occlusive dressing (Tegaderm) to protect the eyes during RP is a simple, affordable and effective way to reduce corneal abrasions. A standardized surgical and anesthetic protocol minimizing length of surgery, fluid resuscitation and tightly controlling ETC02 may help prevent more serious ocular complications such as PION.
H.J. Lavery. Mount Sinai Medical Centre, Dept. of Urology, New YorkUnited States.
Classification:
9.4.15 Glaucoma in relation to systemic disease (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)
15 Miscellaneous
