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PURPOSE: Urologists encounter multiple challenges in managing ureteral stones with ureteroscopic laser lithotripsy. This meta-analysis assesses the effectiveness of alternative surgical positioning, Reverse Trendelenburg (RevTren) and Trendelenburg (Tren), in reducing stone migration and enhancing outcomes compared with standard dorsal lithotomy positioning. MATERIALS AND METHODS: A systematic review was conducted following PRISMA guidelines, searching Medline, Embase, Scopus, Cochrane, and WoS up to March 2024. This review focused on studies evaluating RevTren or Tren positioning during ureteroscopic lithotripsy compared with standard dorsal lithotomy, analyzing end points such as stone migration, conversion rates, success rates, complications, and operative time. RESULTS: Of 137 studies identified, 8 met the inclusion criteria, encompassing 1374 patients. RevTren significantly reduced ureteral stone migration (odds ratio [OR], 0.20; 95% CI, 0.08-0.47), lowered the need for conversion to a flexible ureteroscope (OR, 0.28; 95% CI, 0.12-0.67), and improved success rates (OR, 2.90; 95% CI, 1.88-4.48). Tren increased migration of ureteral and calyceal stones toward upper renal calyces (OR, 2.12; 95% CI, 1.48-3.04) and achieved a higher success rate (OR, 3.56; 95% CI, 2.15-5.92). Complications were comparable across all positions. CONCLUSION: Adjusting patient positioning during ureteroscopic laser lithotripsy can enhance procedure outcomes. RevTren effectively reduces ureteral stone migration and the necessity for flexible ureteroscopes, whereas Tren facilitates ureteral and calyceal stone migration toward upper calyces, increasing success rates. Both positioning techniques offer significant advantages over standard positioning and can be safely adopted in clinical practice without compromising patient safety.
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BACKGROUND AND OBJECTIVES: Although previous reports have shown intraocular pressure changes during robotic-assisted laparoscopic prostatectomy, they did not discuss the time course of changes or the timing of the largest change. We conducted this study to quantify pressure changes over time in patients assuming the steep Trendelenburg position during robotic-assisted laparoscopic prostatectomy. METHODS: Twenty-one men were enrolled. Intraocular pressure was measured before anesthesia induction in the supine position (T0); 30 (T1), 90 (T2), and 150 minutes after assuming the Trendelenburg position (T3); and 30 minutes after reassuming the supine position (T4). End-tidal carbon dioxide and blood pressure were also recorded. To compare intraocular pressure between the time points, we performed repeated-measures analysis of variance. A mixed-effects multivariate regression analysis was conducted to adjust for confounding factors. RESULTS: The mean (standard deviation) intraocular pressure was 18.3 (2.4), 23.6 (3.0), 25.1 (3.1), 25.3 (2.2), and 18.1 (5.0) mmHg at T0, T1, T2, T3, and T4, respectively. The mean intraocular pressure was higher at T1, T2, and T3 than at T0 (p < 0.0001 for all). There was no significant difference between T0 and T4, and between T3 and T2 (p > 0.99 for both). CONCLUSIONS: The Trendelenburg position during robotic-assisted laparoscopic prostatectomy increased intraocular pressure. The increase was moderate at 90 minutes after the position was assumed, with the value being approximately 7 mmHg higher than the baseline value. The baseline intraocular pressure was restored at 30 minutes after the supine position was reassumed. TRIAL REGISTRATION: UMIN ID 000014973 DATE OF REGISTRATION: August 27, 2014.
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Laparoscopia , Procedimentos Cirúrgicos Robóticos , Humanos , Pressão Intraocular , Masculino , Prostatectomia , Tonometria OcularRESUMO
BACKGROUND AND OBJECTIVES: To investigate the effect of the steep Trendelenburg position (35° to 45°) and carbon dioxide (CO2) insufflation on optic nerve sheath diameter (ONSD), intraocular pressure (IOP), and hemodynamic parameters in patients undergoing robot-assisted laparoscopic prostatectomy (RALP), and to evaluate possible correlations between these parameters. METHODS: A total of 34 patients were included in this study. ONSD was measured using ultrasonography and IOP was measured using a tonometer at four time points: T1 (5minutes after intubation in the supine position); T2 (30minutes after CO2 insufflation); T3 (120minutes in steep Trendelenburg position); and T4 (in the supine position, after abdominal exsufflation). Systolic and diastolic arterial pressure, heart rate, and end-tidal CO2 (etCO2) were also evaluated. RESULTS: The mean IOP was 12.4mmHg at T1, 20mmHg at T2, 21.8mmHg at T3, and 15.6mmHg at T4. The mean ONSD was 4.87mm at T1, 5.21mm at T2, 5.30mm at T3, and 5.08 at T4. There was a statistically significant increase and decrease in IOP and ONSD between measurements at T1 and T4, respectively. However, no significant correlation was found between IOP and ONSD. A significant positive correlation was found only between ONSD and diastolic arterial pressure. Mean arterial pressure, heart rate, and etCO2 were not correlated with IOP or ONSD. CONCLUSIONS: A significant increase in IOP and ONSD were evident during RALP; however, there was no significant correlation between the two parameters.
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Laparoscopia , Procedimentos Cirúrgicos Robóticos , Humanos , Pressão Intracraniana , Pressão Intraocular , Masculino , Nervo Óptico/diagnóstico por imagem , Estudos Prospectivos , ProstatectomiaRESUMO
En este trabajo se describe el protocolo quirúrgico practicado en 20 hembras caninas sanas de diferentes edades que fueron sometidas a ovario-histerectomía (OH) laparoscópica; la descripción incluye el instrumental utilizado, la preparación del paciente, la preparación del área quirúrgica, el posicionamiento del animal, la situación de los puertos y las etapas de la técnica quirúrgica mediante el abordaje laparoscópico, así como las posibles complicaciones inherentes a la técnica y las variaciones en las constantes fisiológicas durante el procedimiento operatorio. Las perras se recuperaron de la anestesia sin complicaciones. Los resultados del seguimiento demostraron que la OH mediante laparoscopia puede ser realizada con seguridad y con los mínimos periodos de recuperación y complicaciones transquirúrgicas y posquirúrgicas. La técnica de OH por laparoscopia se convierte además en una alternativa para la realización de diferentes procedimientos quirúrgicos en pequeños animales.
An ovary-hysterectomy (OH) laparoscopic procedure was performed in 20 healthy female dogs of several ages. The surgical protocol is described, taking into account the instruments used, patient preparation, surgery area preparation, surgical position of the patient, points localization, and stages of the surgical technique using a laparoscopic procedure. Complications inherent to the technique were also analyzed. The patients recovered of anesthesia without any complications. The OH through laparoscopy can be done safety and with minimum periods of recuperation and trans- and post-surgical complications.
Em 20 fêmeas caninas clinicamente saudáveis de diferentes idades foram conduzidos ovariohisterectomia (OH) laparoscópica. Este artigo descreve o protocolo que inclui os instrumentos cirúrgicos utilizados, a preparação do paciente, preparando a área cirúrgica, o posicionamento do animal, a situação dos portos e as etapas da técnica cirúrgica utilizando a abordagem laparoscópica, e as possíveis complicações inerentes à técnica. Os cães foram recuperados da anestesia sem complicações. Os resultados mostraram que o acompanhamento da técnica de OH pode ser feito por laparoscopia com segurança e com períodos mínimos de recuperação e complicações pós-cirúrgicas e transoperatórias. La técnica de OH por laparoscopia também é uma alternativa para os diversos procedimentos cirúrgicos em pequenos animais.