Lower limb compartment syndrome as a complication of robot‐assisted radical prostatectomy: theUKexperience

Abstract

Objective• To evaluate the incidence of lower limb compartment syndrome (LLCS) in robot-assisted radical prostatectomy (RARP) and the prevalence of risk factors in patients with LLCS. Methods• Data were collected from 17 UK robotic surgery institutions for a multicentre analysis.• Data were used to calculate the incidence of LLCS and the prevalence of risk factors. Results• A total of 3110 RARPs were performed by 17 institutions between 2004 and 2011.• There were nine cases of LLCS, giving an incidence of 0.29%. Seven of these required fasciotomy.• The prevalence of risk factors was as follows: console time >4 h in 8/9 cases, early learning curve (<20 cases) in 3/9 cases; obesity (BMI >30 kg/m 2 ) in 5/9 cases; and peripheral vascular disease in 2/9 cases. One patient with LLCS was positioned incorrectly. Conclusions• The serious complication LLCS occurs in RARP but has a low incidence.• Long operating times, surgical inexperience, poor patient positioning, obesity and vascular disease appear to be risk factors.

Training robotic surgery in urology: experience and opinions of robot urologists

“…Serious complications, such as lower limb compartment syndrome, are described for robot-assisted laparoscopy and seem to be related to suboptimal learning, i.e. inexperienced operators and prolonged operating time (6).…”

Avoiding, diagnosing and treating well leg compartment syndrome after pelvic surgery

“…As the factor common to published case reports (where this is stated) has generally been an operating time exceeding 4 h, it is recommended that care is taken to document the interval during which the legs are elevated above the heart, and to restrict this to a maximum unbroken period of 4 h. Where technical difficulties or operative challenges prevent safe lowering of the patient's legs (for example, because of the need to control pelvic bleeding), the risk to the patient from lowering the legs may exceed the risk of WLCS.…”

Robotic urologic surgery complications

“…Urologist should be cautious about patients with leg pain in recovery period and early refer the suspected cases to a specialist. During the learning curve, careful case selection and active mentorship is recommended to keep console time < 4 h [47] .…”