Lister Hospital, Coreys Mill Ln, Stevenage, SG1 4AB, UK.
Flinders Medical Centre, Adelaide, Australia.
J Robot Surg. 2024 Jan 19;18(1):46. doi: 10.1007/s11701-023-01771-z.
This study aims to review ophthalmic injuries sustained during of robotic-assisted laparoscopic prostatectomy (RALP). A search of Medline, Embase, Cochrane and grey literature was performed using methods registered a priori. Eligible studies were published 01/01/2010-01/05/2023 in English and reported ophthalmic complications in cohorts of > 100 men undergoing RALP. The primary outcome was injury incidence. Secondary outcomes were type and permanency of ophthalmic complications, treatments, risk factors and preventative measures. Nine eligible studies were identified, representing 100,872 men. Six studies reported rates of corneal abrasion and were adequately homogenous for meta-analysis, with a weighted pooled rate of 5 injuries per 1000 procedures (95% confidence interval 3-7). Three studies each reported different outcomes of xerophthalmia, retinal vascular occlusion, and ophthalmic complications unspecified in 8, 5 and 2 men per 1000 procedures respectively. Amongst identified studies, there were no reports of permanent ophthalmic complications. Injury management was poorly reported. No significant risk factors were reported, while one study found African-American ethnicity protective against corneal abrasion (0.4 vs. 3.9 per 1000). Variables proposed (but not proven) to increase risk for corneal abrasion included steep Trendelenburg position, high pneumoperitoneum pressure, prolonged operative time and surgical inexperience. Compared with standard of care, occlusive eyelid dressings (23 vs. 0 per 1000) and foam goggles (20 vs. 1.3 per 1000) were found to reduce rates of corneal abrasion. RALP carries low rates of ophthalmic injury. Urologists should counsel the patient regarding this potential complication and pro-actively implement preventative strategies.
本研究旨在回顾机器人辅助腹腔镜前列腺切除术（RALP）中发生的眼部损伤。通过预先注册的方法，对 Medline、Embase、Cochrane 和灰色文献进行了搜索。合格的研究于 2010 年 1 月 1 日至 2023 年 1 月 5 日以英文发表，报道了>100 名接受 RALP 的男性队列中的眼部并发症。主要结局是损伤发生率。次要结局是眼部并发症的类型和永久性、治疗、危险因素和预防措施。确定了 9 项合格的研究，代表了 100872 名男性。6 项研究报告了角膜擦伤的发生率，并且可以进行 meta 分析，加权汇总发生率为每 1000 例手术中有 5 例损伤（95%置信区间 3-7）。3 项研究分别报告了干眼症、视网膜血管闭塞和 8、5 和 2 名男性每 1000 例手术中未具体说明的眼部并发症各有不同的结局。在所确定的研究中，没有报告永久性眼部并发症。损伤管理报告不佳。没有报告显著的危险因素，而一项研究发现非裔美国人种族对角膜擦伤有保护作用（0.4 比每 1000 例 3.9）。提出（但未证明）增加角膜擦伤风险的变量包括陡峭的 Trendelenburg 体位、高气腹压力、手术时间延长和手术经验不足。与常规护理相比，闭塞性眼睑敷料（23 比每 1000 例 0）和泡沫护目镜（20 比每 1000 例 1.3）可降低角膜擦伤的发生率。RALP 眼部损伤发生率低。泌尿科医生应告知患者该潜在并发症，并积极实施预防策略。
