About 500,000 hysterectomies are performed each year, making the removal of the uterus one of the most common surgeries for American women. Research shows that minimally-invasive procedures like robotic and laparoscopic surgery have reduced patient pain, scarring, and recovery time over the past two decades, with many surgeons across specialties now opting for it instead of open procedures.
But patients are also almost seven times more likely to suffer a scratched cornea when undergoing a robotic hysterectomy than an open hysterectomy, according to a study supported by the University of Chicago Institute for Translational Medicine (ITM) that recently appeared in the journal Anesthesiology.
“One of the possible factors in robotic hysterectomy is that patients are placed in a steep, head-down position at about a 30- to 45-degree angle,” said ITM investigator Steven Roth, MD, the study’s senior author. “The eyes are covered, but they can appear swollen afterward. The swelling that comes from the head-down position could be altering tear duct flow, and dry eyes are one cause of corneal abrasion.”
Roth and his co-investigators have reported the most extensive studies in the world on eye injuries during anesthesia and surgery, ranging from superficial eye injuries like corneal abrasion to blindness following surgeries like spinal fusions.
Patients need to be aware of the risks associated with these procedures, Roth said, and researchers need to learn why corneal abrasions are occurring more commonly during them.
He said that unforeseen effects like these can be found when technology advances.
“While robotic surgery is a tremendous medical advance, we have to consider that technology comes with more than just a price tag – it can come with unexpected consequences for patients,” said Roth, Professor of Anesthesia and Critical Care, Director of Neuroanesthesia, and a member of the Center for Health and Social Sciences (CHeSS).
About five years ago, Roth and his colleagues began noticing that about two patients each month suffered from corneal abrasions after waking up from anesthesia for robotic surgery.
They decided to see how common it was in minimally invasive and open uterus and prostate removal surgeries by analyzing nearly one million cases from the National Inpatient Sample (NIS).
The results: the risk of corneal abrasion increased almost four-fold with laparoscopic hysterectomies and about 6.5-fold with robotic hysterectomies when compared with open procedures.
During laparoscopic surgeries, a small camera is inserted into a tiny cut through the patient’s skin to give doctors better visibility, while robotic procedures add small instruments to the mix that can flex and move beyond the normal range of motion for surgeons’ hands.
Looking ahead, Roth said that he wants to analyze patients’ tear flow and tear film barrier while they are under anesthesia to pinpoint the cause of the corneal abrasions. The team is also trying to understand whether variables like the degree that patients are tilted, obesity, etc., impact the risk of sustaining corneal abrasions.
“Robotic surgery is cutting-edge technology and we’ll likely see more of it,” Roth said. “But this is one of its unexpected consequences, and we need to learn how these corneal abrasions come about.”