steep T-berg time limit?

[Gas you down]

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So what are your limits for time spent in steep trendelenberg for robotic surgeries?
My group has decided 6hrs is approaching the limit. I've also read a study that says de-docking and going supine for 5-7min every two hours can help to mitigate the risk of postoperative visual loss. (i don't think the surgeons would be very receptive to this). Yes also you can minimize hypotension, anemia, and limit fluids....but this is more about when do you tell a surgeon that they have to call it quits.
I am curious as to how others are approaching the problem. Our surgeons have, for the most part, gotten over their learning curve and have shaved their surgical times, but every once in awhile they have a tough long case that could go forever.

 

[RxBoy]

So what are your limits for time spent in steep trendelenberg for robotic surgeries?

With our surgeons, Asystole.

 

[jwk]

So what are your limits for time spent in steep trendelenberg for robotic surgeries?
My group has decided 6hrs is approaching the limit. I've also read a study that says de-docking and going supine for 5-7min every two hours can help to mitigate the risk of postoperative visual loss. (i don't think the surgeons would be very receptive to this). Yes also you can minimize hypotension, anemia, and limit fluids....but this is more about when do you tell a surgeon that they have to call it quits.
I am curious as to how others are approaching the problem. Our surgeons have, for the most part, gotten over their learning curve and have shaved their surgical times, but every once in awhile they have a tough long case that could go forever.

Unfortunately, there really is no hard data to support an absolute time limit. Common sense tells you that 6 hours is a long time. So is 5 hours. So is 4. At one point does one draw the line? Thankfully, POVL is a very rare event, so my guess is that the "study" you refer to sounds reasonable, but has no real basis in fact nor hard data to support it's opinion that you should go supine ever couple hours (why not reverse Tberg? Wouldn't that be even better?)

The simple truth is that using a robot is INCREDIBLY wasteful, and in all but a very small handful of cases, totally unnecessary. That's where the focus should be. I mean really - robotic lap choles? Seriously?

 

[ssmallz]

The simple truth is that using a robot is INCREDIBLY wasteful, and in all but a very small handful of cases, totally unnecessary. That's where the focus should be. I mean really - robotic lap choles? Seriously?

This is one my biggest pet peeves. If it takes me and extra 5 or 10 minutes to do a block to give a pt good post op relief, or I want to use a drug that is slightly more expensive the staff looks down on us. But if a surgeon wants to waste 2 hours of everyone's time and thousands of dollars to do a lap chole using a robot we not only encourage it but also market it

 

[fakin' the funk]

Hop on an OR table and have someone put it in steep Tberg. I did, and felt like $hit with the venous pressure at my head and had dyspnea within 2-3 minutes. Agree that the robotic cases are hugely wasteful and the positioning required is outrageous.

 

[Gas you down]

Unfortunately, there really is no hard data to support an absolute time limit. Common sense tells you that 6 hours is a long time. So is 5 hours. So is 4. At one point does one draw the line? Thankfully, POVL is a very rare event, so my guess is that the "study" you refer to sounds reasonable, but has no real basis in fact nor hard data to support it's opinion that you should go supine ever couple hours (why not reverse Tberg? Wouldn't that be even better?)

The simple truth is that using a robot is INCREDIBLY wasteful, and in all but a very small handful of cases, totally unnecessary. That's where the focus should be. I mean really - robotic lap choles? Seriously?

i will try to find the article. they credentialed a few anesthesiologists to measure transocular pressure every 30 min and the 2 hour interval rest period was what they came up with as their best way to keep it down...