Effect Of Robotic Assisted Laparoscopic Radical Prostatectomy On Optic Nerve Sheath Diameter

Objective To observe the influence of the pneumoperitoneum and Trendelenburg position on the optic nerve sheath diameter(ONSD)of the patients during the robot assisted laparoscopic radical prostatectomy(RALRP),and indirectly reflect the changes of intracranial pressure(ICP)during the operation.Methods The study includes 60 patients,30 patients undergoing RALRP and 30 patients undergoing gastrointestinal surgery(GS).ONSD was measured via sonography at six time points in RAIRP group:5 min before anesthesia induction(T1),5 min after pneumoperitoneum insufflation,(T2),5 min after Trendelenburg positioning with pneumoperitoneum insufflation(T3),30 min after Trendelenburg positioning with pneumoperitoneum insufflation(T4),5 min after Trendelenburg positioning with pneumoperitoneum insufflation(T5),5 min after pneumoperitoneum was released and in supine position(T6).Open surgery was performed in the gastrointestinal operation group.The position of the body remained in the supine position during the operation,and the ONSD was measured at the same time point as the RALRP group.Results The general demographic characteristics of two groups of patients,such as age,height,weight and BMI,were not statistically different(P>0.05).There was no statistically significant difference in ONSD between the two groups at T1(P>0.05).The group RALRP exhibited significantly higher ONSD from T2-T6 than the group GS(P<0.05).There was no difference in ONSD between T1-T6 in gastrointestinal surgery group(P>0.05).In group RALRP,ONSD at T1 is less than T2-T6 significantly(P<0.05),ONSD at T2 is less than T3 and T4 time significantly(P<0.05).ONSD at T6 was lower than T2-T5 significantly,but higher than T1 time significantly(P<0.05).The rate of dizziness in the RALRP group(30.0%)was significantly higher than that in the gastrointestinal surgery group(6.9%)(P<0.05).However,the rate of headache and post-operative nausea and vomiting(PONV)of RAPRL group had no significant difference with the rate of gastrointestinal surgery group.Conclusions In RAPRL,pneumoperitoneum leads to ONSD increased significantly,and when change into the Trendelenburg position,ONSD increased further.This change in ONSD may lead to a higher incidence of postoperative dizziness.After pneumoperitoneum was released and in supine position,ONSD decreased significantly,but in 5 min ONSD did not drop to baseline.