Blinded Measure of Trendelenburg Angle in Pelvic Robotic Surgery

Study Objective: To estimate the Trendelenburg angle needed to perform robotic gynecologic surgical procedures. Design: Cross-sectional study (Canadian Task Force classification III). Setting: Community hospital. Patients: All women undergoing gynecologic pelvic surgery using the da Vinci surgical robot at a single institution between December 2010 and April 2011. Interventions: The primary surgeon determined the Trendelenburg angle needed for adequate visualization to perform surgery defined as small bowel and sigmoid colon displaced out of the surgical field. Measurements and Main Results: The primary outcome, measured in blinded fashion, was the degree of Trendelenburg positioning needed to complete the surgical procedure robotically. Secondary data collected included body mass index, type of surgery performed, maximum end-tidal CO2, and maximum peak inspiratory pressure. Sixteen surgeons performed a total of 104 robotic gynecologic pelvic surgeries during the study. Data were available for 86 cases. The mean Trendelenburg angle used was 28.0 degrees (95% confidence interval, 26.9-29.1). This was significantly less than the 40 degrees (p < .001) commonly recommended. The Trendelenburg angle used did not correlate with body mass index (r = -0.2; p = .13) or type of surgery performed (p = .41). Neither the maximum end-tidal CO2 or maximum peak inspiratory pressure was influenced by the Trendelenburg angle used when adjusted for age and body mass index. Conclusions: A mean Trendelenburg angle of 28.0 degrees was adequate to complete most gynecologic robotic surgical procedures when compared with historical control angle of 40 degrees. Journal of Minimally Invasive Gynecology (2012) 19, 465-468 (C) 2012 AAGL. All rights reserved.