Nuzzi Raffaele, Tridico Federico
a Eye Clinic Section, University of Turin , Orbassano , Turin , Italy.
Semin Ophthalmol. 2016;31(6):584-92. doi: 10.3109/08820538.2015.1009557. Epub 2015 Apr 30.
During laparoscopic surgery, ocular complications are possible, sometimes leading to devastating visual losses, hardly susceptible to recovery, although rare. Principal ocular adverse events are represented by corneal abrasions and the perioperative visual loss (POVL). POVL onset is related to intraocular pressure elevations (particularly after patient positioning in Trendelenburg or prone decubitus, depending on the surgical procedure), anesthesiologic factors and patients' characteristics. In the light of evidence from the existing literature, the authors suggest surgical and anesthesiologic measures to prevent and manage ocular complications in laparoscopic surgery. Apart from general recommendations, this article indicates practical guidelines specific for robot-assisted laparoscopic interventions and spinal surgery, as well as laparoscopic colorectal resection, radical prostatectomy, and gynecologic surgery. In conclusion, in order to better manage these complications, it is advisable to develop an interdisciplinary collaboration between surgeons, anesthesiologists, and ophthalmologists, on a procedural and medico-legal level, with the intent of mutual training.
在腹腔镜手术期间，眼部并发症是有可能发生的，尽管罕见，但有时会导致严重的视力丧失，且几乎难以恢复。主要的眼部不良事件包括角膜擦伤和围手术期视力丧失（POVL）。POVL的发生与眼压升高（特别是根据手术操作，患者处于特伦德伦伯格体位或俯卧位后）、麻醉因素和患者特征有关。根据现有文献的证据，作者提出了预防和处理腹腔镜手术中眼部并发症的外科和麻醉措施。除了一般建议外，本文还指出了机器人辅助腹腔镜手术、脊柱手术以及腹腔镜结直肠切除术、根治性前列腺切除术和妇科手术的具体实用指南。总之，为了更好地处理这些并发症，建议外科医生、麻醉医生和眼科医生在程序和医疗法律层面开展跨学科合作，以进行相互培训。
