{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:27:54Z","timestamp":1787776074450,"version":"build-2784847793"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>Raised intracranial pressure (ICP) is believed to be one of the side effects of prolonged Trendelenburg position in robotic gynecologic surgeries. Optic nerve sheath diameter (ONSD) corresponds to a rise in ICP. However, the data from robotic hysterectomy surgeries is limited. So, we had planned this study with an aim to detect and compare the change in ONSD during prolonged steep Trendelenburg position in robotic hysterectomy compared to open total abdominal hysterectomy in a supine position.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods:<\/jats:title>\n                    <jats:p>\n                      This was a prospective, observational, parallel-group, single-center study. Patients undergoing elective robotic hysterectomy and open total abdominal hysterectomy were included in this study. ONSD, end-tidal carbon dioxide (EtCO\n                      <jats:sub>2<\/jats:sub>\n                      ), heart rate, and mean arterial pressure were assessed in both the groups after intubation (T0), after steep Trendelenburg position (T1), at 30 min (T2), 90 min (T3), and 180 min after docking (T4), and at the completion of surgery (de-docking) (T5). In patients undergoing open hysterectomy, the same parameters were recorded immediately after intubation (T0), at skin incision (T1), at 30 min (T2), 90 min (T3), and 180 min after skin incision (T4), and at the completion of surgery (T5).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Compared to the patients undergoing open hysterectomy, robotic hysterectomy patients had a significantly higher ONSD at time points T2, T3, and T4, with the maximum difference noted at the time point T4. EtCO\n                      <jats:sub>2<\/jats:sub>\n                      was higher in patients undergoing robotic hysterectomy, though the difference was significant only at time point T2. No patient in our study had any symptom or sign of raised ICP in the postoperative period.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The steep Trendelenburg position used in robotic hysterectomy causes a significant increase in ONSD intraoperatively, and that the changes are reversible after the procedure. Further, we did not observe any complication of raised ICP postoperatively.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/joacp.joacp_348_23","type":"journal-article","created":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T09:00:09Z","timestamp":1737536409000},"page":"133-139","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Evaluation of optic nerve sheath diameter in patients undergoing robotic hysterectomy in steep Trendelenburg position compared to open abdominal hysterectomy in supine position: A randomized controlled trial"],"prefix":"10.4103","volume":"41","author":[{"given":"Deepak","family":"Singla","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T","family":"Mageshwaran","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yashwant S.","family":"Payal","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruma","family":"Thakuria","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kajal","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,1,23]]},"reference":[{"key":"R1-20250122","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1007\/s00268-007-9424-5","article-title":"Effect of posture and prolonged pneumoperitoneum on hemodynamic parameters during laparoscopy","volume":"32","author":"Meininger","year":"2008","journal-title":"World J Surg"},{"key":"R3-20250122","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1007\/s12028-011-9606-8","article-title":"Optic nerve ultrasound for the detection of raised intracranial pressure","volume":"15","author":"Rajajee","year":"2011","journal-title":"Neurocrit Care"},{"key":"R4-20250122","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1111\/j.1553-2712.2007.00031.x","article-title":"Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure","volume":"15","author":"Kimberly","year":"2008","journal-title":"Acad Emerg Med"},{"key":"R5-20250122","first-page":"15","article-title":"Sonographic optic nerve sheath diameter as a screening tool for detection of elevated intracranial pressure","volume":"1","author":"Amini","year":"2013","journal-title":"Emerg (Tehran)"},{"key":"R6-20250122","doi-asserted-by":"crossref","first-page":"1704","DOI":"10.1007\/s00134-007-0797-6","article-title":"Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury","volume":"33","author":"Geeraerts","year":"2007","journal-title":"Intensive Care Med"},{"key":"R7-20250122","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/j.2205-0140.2009.tb00005.x","article-title":"Ultrasound of the eye","volume":"12","author":"Southern","year":"2009","journal-title":"Australas J Ultrasound Med"},{"key":"R8-20250122","first-page":"607","article-title":"The effect of robotic surgery on intraocular pressure and optic nerve sheath diameter:A prospective study","volume":"71","author":"Balkan","year":"2021","journal-title":"Braz J Anesthesiol"},{"key":"R9-20250122","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s12871-015-0025-9","article-title":"Sonographic optic nerve sheath diameter as a surrogate measure for intracranial pressure in anesthetized patients in the Trendelenburg position","volume":"15","author":"Chin","year":"2015","journal-title":"BMC Anesthesiol"},{"key":"R10-20250122","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s12871-017-0333-3","article-title":"Changes in intraocular pressure and optic nerve sheath diameter in patients undergoing robotic-assisted laparoscopic prostatectomy in steep 45\u00b0Trendelenburg position","volume":"17","author":"Blecha","year":"2017","journal-title":"BMC Anesthesiol"},{"key":"R11-20250122","doi-asserted-by":"crossref","first-page":"239","DOI":"10.4103\/1658-354X.154693","article-title":"Noninvasive intracranial pressure monitoring via optic nerve sheath diameter for robotic surgery in steep Trendelenburg position","volume":"9","author":"Shah","year":"2015","journal-title":"Saudi J Anaesth"},{"key":"R12-20250122","doi-asserted-by":"crossref","first-page":"537","DOI":"10.4103\/ija.IJA_861_18","article-title":"A study to evaluate effect of PEEP and end-tidal carbon dioxide on optic nerve sheath diameter","volume":"63","author":"Bala","year":"2019","journal-title":"Indian J Anaesth"},{"key":"R13-20250122","doi-asserted-by":"crossref","first-page":"2272","DOI":"10.1016\/j.transproceed.2012.12.032","article-title":"Ultrasonographic optic nerve sheath diameter is correlated with arterial carbon dioxide concentration during reperfusion in liver transplant recipients","volume":"45","author":"Seo","year":"2013","journal-title":"Transplant Proc"},{"key":"R14-20250122","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1097\/ANA.0000000000000106","article-title":"Detection of elevated intracranial pressure in robot-assisted laparoscopic radical prostatectomy using ultrasonography of optic nerve sheath diameter","volume":"27","author":"Whiteley","year":"2015","journal-title":"J Neurosurg Anesthesiol"},{"key":"R15-20250122","doi-asserted-by":"crossref","first-page":"42063","DOI":"10.1038\/srep42063","article-title":"Noninvasive and quantitative intracranial pressure estimation using ultrasonographic measurement of optic nerve sheath diameter","volume":"7","author":"Wang","year":"2017","journal-title":"Sci Rep"},{"key":"R16-20250122","doi-asserted-by":"crossref","first-page":"1963","DOI":"10.1161\/STROKEAHA.109.577320","article-title":"Continuous assessment of cerebral autoregulation with near-infrared spectroscopy in adults after subarachnoid hemorrhage","volume":"41","author":"Zweifel","year":"2010","journal-title":"Stroke"},{"key":"R17-20250122","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1007\/s12028-009-9250-8","article-title":"Reliability of optic nerve ultrasound for the evaluation of patients with spontaneous intracranial hemorrhage","volume":"11","author":"Moretti","year":"2009","journal-title":"Neurocrit Care"},{"key":"R18-20250122","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1136\/emj.2008.058453","article-title":"Optic nerve sonography:A new window for the non-invasive evaluation of intracranial pressure in brain injury","volume":"26","author":"Soldatos","year":"2009","journal-title":"Emerg Med J"},{"key":"R19-20250122","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1111\/j.1399-6576.2011.02432.x","article-title":"Ultrasonography of the optic nerve in neurocritically ill patients","volume":"55","author":"Moretti","year":"2011","journal-title":"Acta Anaesthesiol Scand"}],"container-title":["Journal of Anaesthesiology Clinical Pharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/joacp.joacp_348_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:50:28Z","timestamp":1787773828000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/joacp.joacp_348_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/joacp.joacp_348_23","relation":{},"ISSN":["0970-9185","2231-2730"],"issn-type":[{"value":"0970-9185","type":"print"},{"value":"2231-2730","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]},"assertion":[{"value":"2023-08-07","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-12-06","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}