Risk for eye injuries associated with RALP for prostate cancer

One might reasonably be pardoned for not being able to imagine how having a radical prostatectomy with robot assistance (a robot-assisted laparoscopic prostatectomy or RALP) could possibly be associated with eye injuries, given the relative lack of proximity of the organs concerned.

However, according to a report on HealthDay, Dr. Ajay Sampat and colleagues at the University of Chicago have just reported (at the annual meeting of the American Society of Anesthesiologists) that, between 2000 and 2009, there has been a significant increase in the numbers of men with eye injuries following RALP.

To be precise, the authors reviewed data from 136,000 RALPs and discovered that the incidence of eye injuries in the patients increased from 0.07 percent in 2001 to 0.42 percent in 2009. In other words, about 1 in every 240 patients undergoing a RALP today will have an eye injury after their surgery, as compared to about 1 in 1,430 in the year 2000. This appears to be about a six-fold increase in risk according to our calculations.

Obviously this is still a relatively small risk — particularly when one considers that most of these “injuries” were small scratches or abrasions to the surface of the cornea of the eye (as opposed to any type of severe traumatic injury).

Apparently it is not yet clear to anyone why this increase in eye injuries has occurred. The researchers have only been able, at this time, to suggest some possibilities, as follows:

  • During a RALP, the patient is customarily placed in an inclined “head down” position (i.e., facing upwards, but with the head much lower than the feet), which may increase his risk for things that include facial swelling, arm injuries, and corneal and other eye injuries.
  • Causes for the eye injuries during robotic-assisted radical prostatectomy could include the long duration of surgery, patient positioning, or even “something associated with the robot itself.”

According to Dr. Sampat, “It is important for patients who are considering a robotic operation to discuss these concerns with their health care providers to consider the risks and benefits of all options, and physicians caring for patients undergoing [robotic-assisted radical prostatectomy] should be more watchful of these potential injuries and take the necessary steps to help prevent them.”

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