Laparoscopic positioning and nerve injuries

Barnett, Jason C.; Hurd, William W.; Rogers, Robert M.; Williams, Ned L.; Shapiro, Scott

doi:10.1016/j.jmig.2007.04.008

Cited by 55 publications

(31 citation statements)

References 18 publications

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“…Nerve injuries are estimated to result in permanent neurological damage in 20%-45% of patients with symptoms (Navarro-Vicente et al, 2012), and the incidence after advanced laparoscopic procedures ranges from 0.16%-6.7% between studies (Barnett, Hurd, Rogers, Williams, & Shapiro, 2007;Mills et al, 2013). The aetiology of perioperative peripheral nerve injury can be a result of a variety of factors and has been suggested to be associated with patientrelated factors such as anatomical conditions, comorbidities, surgical positioning and surgical circumstances (Welch et al, 2009).…”

Section: Nerve Injuriesmentioning

confidence: 99%

Patient‐reported extremity symptoms after robot‐assisted laparoscopic cystectomy

Johansson

Vogelsang

2019

Journal of Clinical Nursing

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Aims and objectives To describe patient‐reported extremity symptoms after robot‐assisted laparoscopic cystectomy in patients with bladder cancer. Background Preventive activities for remaining patient safety due to correct positioning play an important part in perioperative nursing care.Extremity injuries are well‐known after prolonged surgery, especially in robot‐assisted urologic surgery in the steep Trendelenburg position. The risk of injury increases due to patient‐related and operative risk factors. Methods A quantitative prospective observational study was conducted. Patients were followed up with the QuickDASH (Disabilities in the Arm, Shoulder and Hand), Lower Extremity Functional Scale (LEFS) and a study‐specific questionnaire 7–10 days and monthly, up to six months after surgery in patients with extremity symptoms. The study adheres to STROBE (strengthening the reporting of observational studies in epidemiology) guidelines, see Supporting information File S1. Results Out of the 94 included participants, 46.8% (n = 44) experienced extremity symptoms 7–10 days after surgery. Pain, numbness and weakness were the most frequent symptoms. There was a discrepancy between the patients reported symptoms and the documentation in the patient records. Only 13.6% (n = 3) of the reported pain was documented, respectively 27.5% (n = 11) of other symptoms. Conclusion A large proportion of the patients report postoperative extremity symptoms after robot‐assisted laparoscopic cystectomy. Prevention of complications in the perioperative setting, are together with follow‐ups, important nursing activities for maintaining patient safety and may both prevent and detect postoperative extremity symptoms and injuries. Relevance to clinical practice This study reveals the need of accurate documentation regarding extremity symptoms in digital patient records, as well as continuous follow‐ups during the hospital stay and after hospital discharge to enable detection of treatable extremity injuries. The result of this study also indicates the importance of nursing activities such as evidence‐based positioning guidelines in the operating theatre for optimal positioning.

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Section: Nerve Injuriesmentioning

confidence: 99%

Patient‐reported extremity symptoms after robot‐assisted laparoscopic cystectomy

Johansson

Vogelsang

2019

Journal of Clinical Nursing

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“…Dies kann durch die extremen Seitlagerungen während der laparoskopischen Operationen bedingt sein, da das Patientengewicht auf dem Nerv lastet. Im Fall der Plexus-brachialis-Läsionen ist die Inzidenz für lagerungsbedingte Nervenschäden deutlich geringer ausgeprägt, als es Barnett et al in ihrer Arbeit angeben [10]. Interessanterweise traten die Plexusläsionen in dem Zeitraum auf, in dem wir den linken Arm ausgelagert hatten.…”

Section: Datenerhebungunclassified

“…In unserer Untersuchung bestätigten sichanders als in der Arbeit von Navarro-Vicente et al [18] die Hinweise, dass ein erhöhter BMI und eine verlängerte Operationsdauer als Risikofaktoren für lagerungsbedingte Nervenläsionen anzusehen sind. Insbesondere während Operationen in Steinschnittlagerung erhöht sich das Risiko für Nervenschädigungen der unteren Extremität um das 100-Fache für jede verstrichene Operationsstunde [10]. Trotzdem darf man nicht außer Acht lassen, dass auch bei der initialen Lagerung bereits Nervenläsionen durch plötzliche unnatürliche Druck-bzw.…”

Section: Datenerhebungunclassified

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Lagerungsbedingte Nervenläsionen in der laparoskopischen kolorektalen Chirurgie

et al. 2013

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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.

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“…a large uterine myoma[11]. We report a case of gait disturbance due to compression of the lumbosacral plexus caused by uterine myoma and recovery after hysterectomy.…”

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confidence: 93%

A Case of Gait Disturbance Resolved with Hysterectomy in a Woman

Chung

2019

Soonchunhyang Med Sci

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Uterine leiomyoma is the most common benign tumors in females and varies widely in size. Lumbosacral plexopathy is a rare disorder characterized by a sudden onset of leg paresthesia, muscle weakness, and reduction of deep tendon reflexes. This condition usually caused by compression from an abdominal mass, paralysis in mothers during labor, and compression of the lumbosacral plexus by the fetal head during dystocia. This case report presents a 55-year-old woman with a huge uterine myoma and symptoms of weakness of the right leg and gait disturbance. She was diagnosed with lumbosacral plexopathy that resolved after a laparoscopic-assisted total hysterectomy.

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Laparoscopic positioning and nerve injuries

Cited by 55 publications

References 18 publications

Patient‐reported extremity symptoms after robot‐assisted laparoscopic cystectomy

Patient‐reported extremity symptoms after robot‐assisted laparoscopic cystectomy

Lagerungsbedingte Nervenläsionen in der laparoskopischen kolorektalen Chirurgie

A Case of Gait Disturbance Resolved with Hysterectomy in a Woman

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