Prospective randomized controlled trial comparing cephalad migration in robotic gynecologic surgery using egg-crate foam versus the Pink Pad

• Published in: Journal of robotic surgery 2020-04, Vol.14 (2), p.343-347
• Main Authors: Steck-Bayat, Kayvahn P., Henderson, Stephanie, Aguirre, Andrea G., Smith, Rachael B., Mahnert, Nichole M., Gerkin, Richard D., Mourad, Jamal
• Format: Article
• Language: English
• Subjects: Anesthesia; Body mass index; Body size; Correlation; Gynecological surgery; Laparoscopy; Medicine; Medicine & Public Health; Migration; Minimally Invasive Surgery; Original Article; Patient positioning; Robotic surgery; Robotics; Surgeons; Surgery; Urology
• ISSN: 1863-2483; 1863-2491
• DOI: 10.1007/s11701-019-00990-7

The objectives of the study were to compare the cephalad migration of two patient positioning pads used in robotic gynecologic surgery and to determine if any correlation exists between cephalad movement and time in Trendelenburg position or body mass index. This was a prospective randomized controlled open-label trial (Canadian Task Force classification I). Sixty women undergoing robotic-assisted laparoscopic gynecologic surgery were randomized to the Pink Pad ® system or egg-crate foam pre-operatively. Patients were placed under general anesthesia and then positioned in dorsal lithotomy. The locations of the iliac crest, acromion process, and buttock were marked on the table before and after surgery to calculate cephalad migration during surgery. The primary outcome was centimeters of cephalad migration at the three anatomic landmarks. Comparing the Pink Pad ® ( n  = 24) to the egg-crate group ( n  = 26) revealed similar mean cephalad migration at the iliac crest (4.8 cm vs 4.3 cm, p  = 0.56) and the shoulder (4.6 cm vs 3.9 cm, p  = 0.39), and less cephalad migration at the buttock (median 3.0 cm vs 2.0 cm, p  = 0.041). The total time in Trendelenburg was not correlated with cephalad migration at any anatomic landmark. Body mass index was positively correlated with cephalad migration only at the iliac crest ( p  = 0.032) regardless of pad type. The egg-crate foam resulted in less cephalad migration at all anatomic sites and significantly less migration at the buttocks compared to the Pink Pad ® . This suggests that the less-costly egg-crate foam is noninferior to the Pink Pad ® system and trends at superiority.