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Abstract #45659 Published in IGR 13-2
Should patients with glaucoma be offered robotic prostatectomy?
Abaza RJournal of Urology 2011; 185: 4
INTRODUCTION AND OBJECTIVES: Robotic prostatectomy (RP) is the most common surgical therapy for prostate cancer in the United States. The procedure requires steep Trendelenburg positioning to allow access to the prostate deep in the pelvis and to allow gravity retraction of the bowels. Due to the typical facial and neck edema experienced by patients in this position and early data from institutions including our own identifying increased intraocular pressures (IOP) during the procedure, some surgeons and anesthesiologists have denied patients with glaucoma the option of RP. We reviewed our experience with RP in patients with a preoperative diagnosis of glaucoma or ocular hypertension based on our practice of not denying such patients RP. METHODS: A prospectively-collected database of 830 RPs performed from February 2008 to October 2010 by a single surgeon (RA) was reviewed. Patients with a history of glaucoma or ocular hypertension were routinely instructed to visit their ophthalmologist preoperatively to confirm adequate control of their disease and for clearance prior to surgery. Additionally, anesthesia was routinely requested to give no more than 1 liter of intravenous fluids during the procedure when possible even for patients without ocular disease to minimize facial swelling and ease extubation. Perioperative outcomes were compared for those with and without the ocular diseases. RESULTS: A total of 19 affected patients were identified (2%), including 17 with glaucoma and 2 with ocular hypertension. No patient was denied surgery or was unable to obtain clearance from their ophthalmologist. Mean operative time was 153 minutes (range, 108-266min) with all patients also undergoing lymphadenectomy with mean node yield of 11.9 nodes at the time of RP. Residents performed any portion of the procedure at the console in 10 patients (53%). Mean patient BMI was 31kg/m2 (range, 25-44). No patient experienced any changes in vision or other ocular complications. Among patients without glaucoma, mean operative time was also 153 minutes, and mean BMI was 30kg/m2. Estimated blood loss was 132mL (range, 50-200cc) for patients with glaucoma or ocular hypertension and 119mL (range, 10-400cc) for those without. CONCLUSIONS: RP was safely performed in patients with a history of glaucoma or ocular hypertension without postoperative ocular complications. While evidence exists that IOP rises with the positioning during RP, the absence of clinically evident sequelae does not support a practice of denying RP to patients with glaucoma or ocular hypertension when procedure time is reasonable and judicious use of intravenous fluids is practiced.
R. Abaza. Columbus, United States.
Classification:
15 Miscellaneous
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)
6.1.3 Factors affecting IOP (Part of: 6 Clinical examination methods > 6.1 Intraocular pressure measurement; factors affecting IOP)
12.17 Anesthesia (Part of: 12 Surgical treatment)
