Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
J Robot Surg. 2021 Aug;15(4):553-559. doi: 10.1007/s11701-020-01139-7. Epub 2020 Aug 17.
To evaluate the feasibility and outcomes of performing robot-assisted pelvic surgery at a reduced angle of Trendelenburg position. This was a prospective case-control study of 67 patients in 2:1 ratio. Controls were operated with steep Trendelenburg position of 30°, whereas cases were operated using a graduated method to achieve minimal optimal angle of operating table. Various body habitus parameters, console time, blood loss, rise in mean arterial pressure (MAP) and end-tidal carbon-dioxide (ET-CO), duration of ileus, postoperative stay and complications were recorded. All demographic profile and body habitus parameters were comparable among two groups except age which was lower in Reduced-Tilt group. Cases were operated at a mean angle of 20.5 ± 3.1° compared to 30° in control group. Rise in MAP, ET-CO and facial swelling were significantly low in Reduced-Tilt group compared to control. Notably blood loss, duration of ileus, postoperative stay and complications were also low in patients with Reduced Tilt. Various body habitus parameters were analysed with multiple regression analysis to predict minimal angle required for performing surgery with Reduced Tilt. BMI, xiphisterno-umbilical distance, umbilical-pubic-symphyseal distance and subcostal angle were found to predict the same. Robot-assisted pelvic surgeries can be performed in reduced Trendelenburg tilt which is associated with less hemodynamic and respiratory stress, complication rates and early postoperative recovery. BMI, subcostal angle, xiphisterno-umbilical distance and umbilical-pubic-symphyseal distance can predict the feasible angle of tilt.
评估在降低头低脚高倾斜角度下进行机器人辅助骨盆手术的可行性和结果。这是一项前瞻性病例对照研究，纳入了 67 例患者，比例为 2:1。对照组采用 30°的陡头低脚高倾斜角度，而病例组采用逐渐降低的方法，以达到最小的最佳手术台角度。记录了各种身体形态参数、控制台时间、出血量、平均动脉压 (MAP) 和呼气末二氧化碳 (ET-CO) 升高、肠梗阻持续时间、术后住院时间和并发症。两组之间的所有人口统计学特征和身体形态参数都相似，除了年龄，降低倾斜组的年龄较低。病例组的手术平均角度为 20.5±3.1°，而对照组为 30°。与对照组相比，降低倾斜组的 MAP、ET-CO 和面部肿胀升高显著较低。值得注意的是，降低倾斜组的出血量、肠梗阻持续时间、术后住院时间和并发症也较低。使用多元回归分析对各种身体形态参数进行分析，以预测使用降低倾斜角度进行手术所需的最小角度。BMI、剑突-脐距离、脐耻骨联合距离和肋下角被发现可以预测相同的角度。机器人辅助骨盆手术可以在降低的头低脚高倾斜角度下进行，这与较少的血流动力学和呼吸系统应激、并发症发生率和早期术后恢复有关。BMI、肋下角、剑突-脐距离和脐耻骨联合距离可以预测可行的倾斜角度。
