Lessons Learned from a Case of Calf Compartment Syndrome After Robot-Assisted Laparoscopic Prostatectomy

Rosevear, Henry; Lightfoot, Andrew J.; Zahs, Marta; Waxman, Steve; Winfield, Howard N.

doi:10.1089/end.2009.0666

Cited by 20 publications

(12 citation statements)

References 12 publications

(11 reference statements)

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“…Copious padding of pressure points is needed to avoid compression injuries, this is especially important during the early LC when operating times can extend to 6 h. 15 Severe nerve injuries including calf compartment syndrome have been described following RARP, 16 and gluteal compartment syndrome has been reported following robotic pyeloplasty. 17 Prolonged surgery appears critical in the aetiology of this condition with more than 4 h of ischaemia leading to myonecrosis and myoglobinuria; this places RARP well within reach of this serious complication 18 and mentored cases should have a maximum of a 4-h console time.…”

Section: Patient Positioningmentioning

confidence: 99%

Overcoming the challenges of robot-assisted radical prostatectomy

Goldstraw¹,

Challacombe

Patil

et al. 2011

Prostate Cancer Prostatic Dis

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Section: Patient Positioningmentioning

confidence: 99%

Overcoming the challenges of robot-assisted radical prostatectomy

Goldstraw¹,

Challacombe

Patil

et al. 2011

Prostate Cancer Prostatic Dis

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“…Compartment syndrome is a rare complication of the surgery due to specific positioning of the patient [ 41 – 43 ]. The compartment syndrome in upper and lower extremities in the robotic surgery was previously reported [ 44 , 45 ]. It may be explained not only by the fact that the robotic surgery requires unique positioning of the patient but also that the position cannot be easily changed after the da Vinci system is docked.…”

Section: Discussionmentioning

confidence: 94%

Implementation of a Robotic Surgical Program in Gynaecological Oncology and Comparison with Prior Laparoscopic Series

Povolotskaya

Woolas

Brinkmann

2015

International Journal of Surgical Oncology

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Background. Robotic surgery in gynaecological oncology is a rapidly developing field as it offers several technical advantages over conventional laparoscopy. An audit was performed on the outcome of robotic surgery during our learning curve and compared with recent well-established laparoscopic procedure data. Method. Following acquisition of the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA), we prospectively analysed all cases performed over the first six months by one experienced gynaecologist who had been appropriately trained and mentored. Data on age, BMI, pathology, surgery type, blood loss, morbidity, return to theatre, hospital stay, and readmission rate were collected and compared with a consecutive series over the preceding 6 months performed laparoscopically by the same team. Results. A comparison of two consecutive series was made. The mean age was somewhat different, 55 years in the robotic versus 69 years in the laparoscopic group, but obesity was a feature of both groups with a mean of BMI 29.3 versus 28.06, respectively. This difference was not statistically significant (P = 0.54). Three subgroups of minimal access surgical procedures were performed: total hysterectomy and bilateral salpingooophorectomy (TH + BSO), total hysterectomy and bilateral salpingooophorectomy plus bilateral pelvic lymphadenectomy (TH + BSO + BPLND), and radical hysterectomy plus bilateral pelvic lymphadenectomy (RH + BPLND). The mean time taken to perform surgery for TH + BSO was longer in the robotic group, 151.2 min compared to 126.3 min in the laparoscopic group. TH + BSO + BPLND surgical time was similar to 178.3 min in robotic group and 176.5 min in laparoscopic group. RH + BPLND surgical time was similar, 263.6 min (robotic arm) and 264.0 min (laparoscopic arm). However, the numbers in this initial analysis were small especially in the last two subgroups and do not allow for statistical analysis. The rate of complications necessitating intervention (Clavien-Dindo classification grade 2/3) was higher in the robotic arm (22.7%) compared to the laparoscopic approach (4.5%). The readmission rate was higher in the robotic group (18.2%) compared to the laparoscopic group (4.5%). The return to theatre in the robotic group was 18.2% and 4.5% in laparoscopic group. Uncomplicated robotic surgery hospital stay appeared to be shorter, 1.3 days compared to the uncomplicated laparoscopic group, 2.5 days. There was no conversion to the open procedure in either arm. Estimated blood loss in all cases was less than 100 mL in both groups. Conclusion. Robotic surgery is comparable to laparoscopic surgery in blood loss; however, the hospital stay in uncomplicated cases appears to be longer in the laparoscopic arm. Surgical robotic time is equivalent to laparoscopic in complex cases but may be longer in cases not requiring lymph node dissection. The robotic surgery team learning curve may be associated with higher rate of morbidity. Further research on the benefits to the surgeon is needed to clarify th...

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“…For instance, ensuring intraoperative repositioning of the legs every 2 h can avoid the buildup of pressure in the popliteal fossa and minimize torsion of the popliteal artery; knee flexion beyond 90° should be avoided; when available, external compression devices should be used; and pressure from the surgical assistant on the patient's hip should be avoided. 3 , 6 , 14 - 17 …”

Section: Discussionmentioning

confidence: 99%

Bilateral compartment syndrome of the lower limbs after urological surgery in the lithotomy position: a clinical case

et al. 2019

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Acute compartment syndrome of the lower extremities after urological surgery in the lithotomy position is a rare but potentially devastating clinical and medicolegal problem. We report the case of a 67-year-old male who underwent laparoscopic prostatectomy surgery to treat cancer, spending 180 minutes in surgery. Postoperatively, the patient developed acute compartment syndrome of both legs, needing emergency bilateral four-compartment fasciotomies, with repeated returns to the operating room for second-look procedures. The patient also exhibited delayed wound closure. He regained full function within 6 months, returning to unimpaired baseline activity levels. This report aims to highlight the importance of preoperative awareness of this severe complication which, in conjunction with early recognition and immediate surgical management, may mitigate long-term adverse sequelae and improve postoperative outcomes.

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Lessons Learned from a Case of Calf Compartment Syndrome After Robot-Assisted Laparoscopic Prostatectomy

Cited by 20 publications

References 12 publications

Overcoming the challenges of robot-assisted radical prostatectomy

Overcoming the challenges of robot-assisted radical prostatectomy

Implementation of a Robotic Surgical Program in Gynaecological Oncology and Comparison with Prior Laparoscopic Series

Bilateral compartment syndrome of the lower limbs after urological surgery in the lithotomy position: a clinical case

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