Influence of steep Trendelenburg position on postoperative complications: a systematic review and meta-analysis

Satoshi Katayama, Keiichiro Mori, Benjamin Pradere, Takafumi Yanagisawa, Hadi Mostafaei, Fahad Quhal, Reza Sari Motlagh, Ekaterina Laukhtina, Nico C. Grossmann, Pawel Rajwa, Abdulmajeed Aydh, Frederik König, Pierre I. Karakiewicz, Motoo Araki, Yasutomo Nasu, Shahrokh F. Shariat

Research output: Contribution to journalReview articlepeer-review

2 Citations (Scopus)


Intraoperative physiologic changes related to the steep Trendelenburg position have been investigated with the widespread adoption of robot-assisted pelvic surgery (RAPS). However, the impact of the steep Trendelenburg position on postoperative complications remains unclear. We conducted a meta-analysis to compare RAPS to laparoscopic/open pelvic surgery with regards to the rates of venous thromboembolism (VTE), cardiac, and cerebrovascular complications. Meta-regression was performed to evaluate the influence of confounding risk factors. Ten randomized controlled trials (RCTs) and 47 non-randomized controlled studies (NRSs), with a total of 380,125 patients, were included. Although RAPS was associated with a decreased risk of VTE and cardiac complications compared to laparoscopic/open pelvic surgery in NRSs [risk ratio (RR), 0.59; 95% CI 0.51–0.72, p < 0.001 and RR 0.93; 95% CI 0.58–1.50, p = 0.78, respectively], these differences were not confirmed in RCTs (RR 0.92; 95% CI 0.52–1.62, p = 0.77 and RR 0.93; 95% CI 0.58–1.50, p = 0.78, respectively). In subgroup analyses of laparoscopic surgery, there was no significant difference in the risk of VTE and cardiac complications in both RCTs and NRSs. In the meta-regression, none of the risk factors were found to be associated with heterogeneity. Furthermore, no significant difference was observed in cerebrovascular complications between RAPS and laparoscopic/open pelvic surgery. Our meta-analysis suggests that the steep Trendelenburg position does not seem to affect postoperative complications and, therefore, can be considered safe with regard to the risk of VTE, cardiac, and cerebrovascular complications. However, proper individualized preventive measures should still be implemented during all surgeries including RAPS to warrant patient safety.

Original languageEnglish
JournalJournal of Robotic Surgery
Publication statusAccepted/In press - 2021


  • Cardiac
  • Complication
  • Meta-analysis
  • Thrombosis
  • Trendelenburg position

ASJC Scopus subject areas

  • Surgery
  • Health Informatics


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