Clinical Trial Summary
Some robotic endoscopic surgeries require a steep Trendelenburg position and a carbon dioxide
pneumoperitoneum. This minimally invasive approach has the advantages of less postoperative
pain, shorter hospital stay and faster recovery. After prolonged operative time in a
Trendelenburg position rare but significant complications are a cerebral oedema or a well leg
compartment syndrome.
Well leg compartment syndrome results from inadequate perfusion in the lower limbs and the
perfusion pressure is decreased proportionally to the lower extremity elevation. The
condition can lead to release of intracellular proteins and myoglobinuria, hyperpotassaemia
and metabolic acidosis followed by cell necrosis. The risk for tissue damage increases after
4 hours in a Trendelenburg position.
If not promptly diagnosed and treated, a compartment syndrome has devastating complications
like permanent dysfunction, limb loss, renal failure or even death.
There are no specific guidelines for diagnosis and for the timing of surgical decompression.
Fasciotomy is a clinical decision. There is no universal agreement at which compartment
pressure irreversible muscle damage occurs.
The only objective diagnostic tool available is currently to measure the intramuscular
pressure, however this is invasive, painful and may yield unreliable results. An
intracompartment pressure of 0- 10mm Hg is the normal range.
Near Infrared Spectroscopy (NIRS) monitors are validated and approved to measure cerebral and
somatic tissue oxygenation below the sensors and may help detecting promptly a compartment
syndrome.
Therefore, the investigators designed the present study to detect a change in the tissue
oxygenation in the lower legs during robotic assisted, laparoscopic surgery in the
Trendelenburg position.
