Hand pain during hand assisted laparoscopic nephrectomy--an ischemic event?

Area of Science:

• Urology
• Surgical Innovation
• Occupational Health

Background:

• Hand discomfort is a common complaint among surgeons performing hand-assisted laparoscopic nephrectomy (HALN).
• The etiology of this pain is suspected to be ischemic, potentially related to intraoperative pressures.
• Understanding these risks is crucial for surgeon well-being and procedural efficiency.

Purpose of the Study:

• To determine if sustained pneumoperitoneal pressure during HALN poses an occupational risk.
• To investigate if this pressure contributes to local hand hypoxia and subsequent extremity pain.
• To identify the relationship between intraoperative conditions and surgeon-reported pain.

Main Methods:

• 442 oxygen saturation measurements were taken on the index finger during HALN using a Nellcor OxiMax Max-1 sensor.
• Surgeons used a LapDisc at 15 mm Hg pneumoperitoneal pressure.
• Local oximetry and pain distress scores were recorded every 2 minutes, with readings taken at rest and during motion.

Main Results:

• A history of hand pain was significantly associated with local hypoxia during both motion (p=0.023) and rest (p=0.012).
• Hand pain was most significantly linked to hypoxia after 24 minutes (p=0.0002), with oxygen saturation levels between 56% and 88%.
• Adequate fascial incision and standard pressures did not eliminate the association between hypoxia and pain.

Conclusions:

• Urologists performing HALN are predisposed to ischemic hand pain.
• The pain is likely caused by pneumoperitoneal pressure-induced hypoperfusion and venous congestion.
• While LapDisc constriction is not a major factor with adequate incisions, pain is significant after 24 minutes at 15 mm Hg, warranting further study.