(RxWiki News) At first thought, it may seem difficult to see the connection between prostate surgery and eye injury. You might first think, “Are prostate surgeons that far off target?”
A new study has found a link between robotic prostate surgery and increased eye injury. The surgery itself, however, seems not to be at fault. Eye problems appear to come from the patient’s position, duration of the operation, anesthesia, and other factors.
"Find out how to protect your eyes during prostate surgery."
Ajay Sampat, MD, anesthesiologist, conducted the research while he was a student at the University of Chicago Pritzker School of Medicine. He and his colleagues found that, from the years 2000-2009, eye injuries during robotic-assisted radical prostatectomy (RARP) increased nearly 10-fold.
Removal of the prostate has been a treatment option for prostate cancer patients for decades. In 2000, the U.S. Food and Drug Administration approved robotic surgery for the removal of the prostate.
Today, robotics let doctors perform surgery that is less invasive. Using state-of-the-art technology, surgeons can see anatomical structures more clearly and perform more precise procedures.
Rather than making a six- to eight-inch incision, a surgeon can remove the prostate through small punctures using pencil-sized instruments.
Robotic surgery offers a shorter duration of hospital stay than typical surgery. It is associated with lower infection rates and decreased need for pain medications after surgery.
The cost for robotic-assisted surgery may be much higher than a standard operation. A 2012 study in the July issue of Urology found that overall cost for robotic-assisted surgery was 62% higher than that of traditional prostatectomy ($14,006 vs. $8,686).
The risk to the eyes may come from the patient position, according to Dr. Sampat. A patient undergoing robotic prostate surgery must lie flat on his back at a slant with his feet higher than his head by 15 to 30 degrees.
Called the Trendelenburg position, it can cause facial swelling, arm injury, as well as corneal and other visual injuries, according to investigators. Previous studies have shown that the position can increase pressure exerted by fluids inside the eyeball.
General anesthesia also has been known to cause harm to the eyes. If eyes are not closed during surgery, the cornea can dry out, making it more susceptible to corneal abrasion, or scratching of the eye surface.
Dr. Sampat noted that most of the visual injuries reported on the 136,711 cases in the study were corneal abrasion.
“I suspect the increase in eye injuries, namely corneal abrasions, is unrelated to the actual robot or robotic procedure and may have to do with preparing the patient once asleep and when they are coming out of anesthesia,” said Alvin Goh, MD, urologist and prostate cancer specialist with the Methodist Cancer Center in Houston, Texas. “The patient's head is down during the procedure and the face is often covered with drapes throughout. We always take extra precautions to place protective covering over the eyes prior to draping. Corneal abrasions most commonly occur as the patient is coming out of anesthesia. Extra care should be taken at this time to protect the eyes from injury at the conclusion of any case."
Dr. Goh added that robotic surgery remains a safe and effective treatment option for men with prostate cancer. However, patients with glaucoma or other ocular issues are advised to discuss them with their urologist and eye specialist before surgery.
Although the exact reasons for the increase in eye injury during surgery could not be concluded from the study, Dr. Sampat said the findings could offer guidance for patients undergoing robotic procedures.
“It is important for patients who are considering a robotic operation to discuss these concerns with their health care providers to consider the risks and benefits of all options,” said Dr. Sampat. “And physicians caring for patients undergoing RARP should be more watchful of these potential injuries and take the necessary steps to help prevent them.”
This study was presented at ANESTHESIOLOGY 2012, the annual meeting of the American Society of Anesthesiologists.
