Distinct retinal remodeling and visual prognostic factors in advanced epiretinal membranes with and without associated retinal break.

Laparoscopic major abdominal cancer surgery requires a combination of pneumoperitoneum and Trendelenburg positioning to optimize surgical exposure. Although these positions are mandatory for the surgical procedure, they lead to a number of physiological challenges, especially in oncology patients. In this patient group, factors such as advanced age and cardiovascular comorbidities may impair physiological reserve and increase the risk of postoperative complications, including cognitive changes. The most prominent hemodynamic changes due to pneumoperitoneum and Trendelenburg position are observed after insufflation []. The increase in intra-abdominal pressure due to the pneumoperitoneum causes a decrease in venous return and cardiac output. The negative cardiovascular effects of pneumoperitoneum are alleviated to some extent by the effects of the Trendelenburg position. Complex changes occur in brain perfusion during prolonged Trendelenburg position and pneumoperitoneum. These complications are rare in short-term interventions in healthy people, but are more likely to occur in older, comorbid patients undergoing long, complicated surgery [].These changes are likely to affect cerebral dysfunction and early postoperative cognitive changes. Therefore, monitoring of cerebral tissue oxygen saturation during the operation may be valuable []. The method known as Near Infrared spectroscopy (NIRS) offers a stable, non-invasive and safe method of detecting cerebral desaturation. Monitoring intraoperative cerebral oxygen saturation may help identify patients at higher risk for postoperative cognitive changes. This may help reduce postoperative cognitive issues and decrease the length of hospital stay. The aim of this study is to observe the NIRS changes due to the Trendelenburg position and pneumoperitoneum in patients undergoing laparoscopic major abdominal oncologic surgery and to evaluate their association with early postoperative cognitive changes.