Respiratory Effects of Steep Trendelenberg in Obese and Non-Obese Patients during Robotic Gynecologic Procedures

Abstract

Study Objective: To evaluate the respiratory effects of steep Trendelenberg in obese and non-obese patients during robotic surgery. Design: Retrospective chart review of 100 patients who underwent robotic gynecologic procedures of at least 45 minutes duration. Setting: Tertiary Referral Center. Patients: Women at least 18 years who underwent a robotic gynecologic procedure. Intervention: Robotic gynecologic surgery. Measurements and Main Results: Ventilatory parameters including: Heart rate, mean arterial pressure (MAP), Oxygen saturations, respiratory rate, tidal volume, peak airway pressure, end tidal CO2, FiO2, PEEP, Mode of Ventilation (pressure vs. volume) were evaluated and compared between the 2 groups of patients. Clinical outcomes including need to abort or convert the robotic procedure secondary to difficulty maintaining oxygen saturations, continued endotracheal intubation beyond the operating room, admission to the intensive care unit for ventilation requirements, postoperative pneumonia within one week of surgery, were also evaluated. There were no cases in either group that could not be completed secondary to ventilatory complications and no cases that required admission to the ICU after the procedures. Postoperative pneumonia was rare and did not differ between obese and non-obese patients. Conclusion: Respiratory complications are rare after robotic procedures where patients are placed in steep Trendelenburg despite the potential complications that can arise. Clinical outcomes related to respiratory complications are similar in obese and non-obese patients.