Positioning injuries under recognized in robotic urologic surgery
medwireNews: Researchers are calling for greater attention to the risk for positioning injuries in robotic urologic surgery after finding that the rate could reach up to 40% for some procedures.
Furthermore, the team from the University of Virginia in Charlottesville, USA, reports that over one-fifth of all injuries persisted for at least 6 months, potentially indicating permanent damage.
“Positioning injuries are under recognized in robotic assisted surgery,” Tracey Krupski and colleagues say in the Journal of Urology, adding that “consideration must be given to counseling patients about the risks of positioning injuries, especially with long operations.”
Twenty-two (6.6%) positioning injuries were documented in the 334 robotic-assisted urologic surgery procedures that took place over a 2-year period, using the da Vinci Di and da Vinci Standard Surgical System.
The rate was highest for retroperitoneal lymph node dissection, at 40%, although the authors note that this could be due to the fact that this surgery is performed less frequently.
The second-highest rate was for adrenalectomy, at 17%, while the two most common procedures, radical prostatectomy and partial nephrectomy, each had an injury rate of 7%.
Although 59.1% of all injuries resolved within 1 month, 22.7% persisted beyond 6 months in spite of neurologic physical therapy, and occupational therapy consultation.
The authors found that a higher American Society of Anesthesiologists physical status class was associated with increasing risk for injury, with otherwise healthy patients (class 1) experiencing no injuries. Patients in classes 2 and 3 had a 6.3% and 7.0% injury rate, respectively, while the rate was 50% for class 4 patients (multiple medical comorbidities).
While only four patients were in class 4, the authors say that this group of patients may require special attention, commenting that “careful counseling and offering more conservative options may be prudent in this population.”
They also report that operation time was significantly associated with the risk for positioning injuries; the median time was 328 minutes for operations that resulted in injury compared with a median time of 240 minutes for those that did not. This is consistent with the fact that severity of nerve injury is related to duration of compression, the authors note.
While the effect of upper extremity positioning on injury risk did not reach statistical significance, the authors say they believe this to be an important issue.
They conclude that “optimal patient selection and preoperative management may be key strategies to mitigate the risk of numerous complications including positioning injuries.”
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By Kirsty Oswald, medwireNews Reporter