Lagerungsbedingte Nervenläsionen in der laparoskopischen kolorektalen Chirurgie

Abstract

Laparoscopic colon and rectum operations expose peripheral nerves to risk due to extreme patient positions needed to achieve gravity displacement during the surgical procedures. The general incidence of position-caused nerve injuries in surgery is not well known and is estimated to be about 0.5 % in the literature. There are no current data concerning laparoscopic operations. This study assesses the incidence and outcome of surgery-associated neurological symptoms after laparoscopic colon and rectum surgical procedures. We analysed the number of position-caused nerve injuries and their outcome from 1992-2010 in a prospectively managed data base. Risk factors like age, BMI, procedure duration and abduction of the upper extremities were analysed. There were 19 (0.7 %) position-caused nerve injuries among 2698 laparoscopic operations on the colon and rectum. The incidence of surgery-associated neurological symptoms was 1.08 % after laparoscopic rectum and 0.54 % after laparoscopic colon surgical procedures. Both operation time (267 vs. 185 minutes) and BMI (27.93 vs. 25.79 kg/m(2)) were revealed as risk factors for position-caused nerve injuries. Adduction of the upper extremities reduced the incidence of positioning nerve injuries from 0.23 % to 0.1 %. Postoperative neurological symptoms were in most cases reversible (89.47 %). The incidence of postoperative nerve injuries since 2007 is low after laparoscopic rectum and colon operations and is mostly completely reversible. Both procedure duration and BMI are probable risk factors for surgery-associated nerve injuries. Adduction of the upper extremities provides an opportunity to reduce position-caused nerve injuries.

Factors Associated With Peripheral Nerve Injury After Pelvic Laparoscopy: The Importance of Surgical Positioning

“…According to Al-Temimi et al (2017), patients with a BMI greater than 30 kg/m 2 are at a greater risk of developing nerve injury. Similarly, Ellebrecht et al (2015) related the risk of nerve injury to obesity. In this study, we failed to identify a greater vulnerability to PNI among the participants with a high BMI (> 30 kg/m 2 ).…”

“…Because previous studies have identified prolonged surgical time as a risk factor (Abdalmageed et al, 2017; Al-Temimi et al, 2017; Ellebrecht et al, 2015), all patients aged 18 years old and above who had undergone surgery lasting over 2 hours (from the start to the closure of the surgical incision) were recruited as participants. We excluded patients with spinal cord injury, neurodegenerative disease, preexisting nerve damage in a limb, and/or dementia.…”

Laparoskopisches Ausschalten eines Aneurysmas der A. lienalis

“…Letztere Autoren führten jedoch eine laparoskopische Splenektomie zur Behandlung des Aneurysmas durch, wie dies auch andere Kasuistiken berichten [12]. Prospektiv randomisiert haben Tiberio et al 14 [13].…”