E-Posters-How Much Trendelenburg is Enough? Adequacy of Laparoscopic Pelvic Visualization by Degree of Reverse Tilt

How Much Trendelenburg is Enough? Adequacy of Laparoscopic Pelvic Visualization by Degree of Reverse Tilt - Kyle Mock, MD

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In this study, the researchers aimed to determine the minimum angle of Trendelenburg needed to adequately visualize specific pelvic landmarks during laparoscopic surgery. The study included patients undergoing laparoscopic surgery, with or without robotic assistance. After peritoneal access was obtained, pelvic anatomy was photographed at various angles of Trendelenburg. The researchers focused on three specific landmarks: anterior cul-de-sac, posterior cul-de-sac, and sacral promontory.<br /><br />The study enrolled 9 participants, and complete visualization of the anterior cul-de-sac was achieved in all subjects by -25 degrees of tilt. However, complete visualization of the posterior cul-de-sac and sacral promontory required a greater degree of tilt, specifically -30 degrees, and was achieved in only 44% of participants. The researchers categorized the landmark exposure as 'non-visualized,' 'partially-visualized,' or 'complete visualization,' with their primary outcome being 'complete visualization' without the need for continuous instrument retraction or manipulation.<br /><br />Based on the findings, the researchers concluded that exposure of the anterior cul-de-sac can be achieved at -25 degrees of Trendelenburg, while exposure of the posterior cul-de-sac and sacral promontory requires a higher degree of tilt, specifically -30 degrees, for consistent visualization. These results highlight the importance of understanding the appropriate degree of reverse tilt for optimal visualization during laparoscopic pelvic surgery.

Keywords

laparoscopic surgery

Trendelenburg

pelvic landmarks

robotic assistance

peritoneal access

anterior cul-de-sac

posterior cul-de-sac

sacral promontory

visualization

reverse tilt