Cerebral oxygenation in 45-degree trendelenburg position for robot-assisted radical prostatectomy: a single-center, open, controlled pilot study.

Within the last decade, robotically-assisted laparoscopic prostatectomy (RALP) has become the standard for treating localized prostate cancer, causing a revival of the 45° Trendelenburg position. In this pilot study we investigated effects of Trendelenburg position on hemodynamics and cerebral oxygenation in patients undergoing RALP.

We enrolled 58 patients undergoing RALP and 22 patients undergoing robot-assisted partial nephrectomy (RAPN) (control group) in our study. Demographic patient data and intraoperative parameters including cerebral oxygenation and cerebral hemodynamics were recorded for all patients. Cerebral function was also assessed pre- and postoperatively via the Mini Mental Status (MMS) exam. Changes in parameters during surgery were modelled by a mixed effects model; changes in the MMS result were evaluated using the Wilcoxon signed rank test.

Preoperative assessment of patient characteristics, standard blood values and vital parameters revealed no difference between the two groups.

Applying a 45° Trendelenburg position causes no difference in postoperative brain function, and does not alter cerebral oxygenation during a surgical procedure lasting up to 5 h. Further studies in larger patient cohorts will have to confirm these findings.

German Clinical Trial Registry; DRKS00005094; Registered 12th December 2013-Retrospectively registered; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00005094 .

BMC urology. 2020 Dec 30*** epublish ***

Clemens Wiesinger, Dominik Stefan Schoeb, Mathias Stockhammer, Emir Mirtezani, Lukas Mitterschiffthaler, Helga Wagner, Johann Knotzer, Walter Pauer

Department of Urology, Wels-Grieskirchen Medical-Center, Grieskirchner Straße 42, 4600, Wels, Austria., Department of Urology, Faculty of Medicine, Medical Center - University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany. ., Department of Urology, BHB Salzburg, Kajetanerplatz 1, 5010, Salzburg, Salzburg, Austria., Department of Anesthesiology and Intensive Care II, Wels-Grieskirchen Medical Center, Grieskirchner Straße 42, 4600, Wels, Austria., Medical Statistics and Biometry, Institute for Applied Statistics, Johannes Kepler University Linz, Altenbergerstrasse 69, 4040, Linz, Austria.