Post-operative Visual Loss (POVL)
The steep-Trendelenburg ocular hazard
Prolonged steep head-down tilt
↑ Intra-ocular pressure & orbital/ocular venous congestionWorsened by long operative time, hypotension, anaemia & large-volume crystalloid
↓ Optic-nerve perfusion → ischaemic optic neuropathy → POVL
Mitigation: limit the duration of extreme tilt, avoid hypotension & anaemia, use a restrictive fluid strategy, protect & pad the eyes, and consider intermittent levelling in very long cases.
CO₂-Related & Airway Complications
CO₂ / gas complications
- Subcutaneous emphysema, pneumothorax, pneumomediastinum from CO₂ tracking
- Hypercarbia & respiratory acidosis from absorption
- CO₂ (gas) embolism — sudden ↓ EtCO₂, hypotension, desaturation
Airway & cerebral
- Laryngeal / facial / conjunctival oedema → post-extubation obstruction risk
- Cerebral oedema → delayed emergence
- Endobronchial migration of the ETT after positioning
Position-Related Injuries
The steep tilt + prolonged immobility + shoulder supports risk peripheral nerve injuries (notably brachial plexus from shoulder braces, and lower-limb nerves in lithotomy), pressure injuries over bony prominences, and corneal abrasion. Meticulous padding, correct support placement (avoid direct brachial-plexus pressure) and eye protection are the defence — and none of it can be adjusted once the robot is docked.