Lower extremity neuropathy after robot assisted laparoscopic radical prostatectomy and radical cystectomy

To describe the incidence and outcomes of lower extremity neuropathies in a series of robot assisted laparoscopic radical prostatectomy (RALRP) and robot assisted laparoscopic radical cystectomy (RALRC) patients with 9 months follow up. Additionally, we compare this cohort to other published series of lithotomy based surgery and describe strategies for minimizing risk.

We performed a retrospective analysis of 179 consecutive patients who underwent either RALRP or RALRC at a single institution during a 17 month period. We included all patients who experienced bothersome lower extremity pain, weakness, or numbness at any time during their postoperative course. We further defined postoperative neuropathy as de-novo symptoms presenting in the first week postoperatively. Chart review and telephone survey were used to further characterize these patients.

Six out of 179 patients complained of lower extremity neuropathic symptoms by 9 months of follow up. Probable injuries to the common peroneal, lateral femoral cutaneous, and obturator nerves were found. Three patients met our criteria for postop neuropathy making the incidence 1.68%. All patients remained ambulatory throughout their course. At 9 months follow up, only one patient, a man with metastatic bladder cancer, had activity limiting neuropathic symptoms.

With routine use of common risk minimizing strategies, RALRP or RALRC may result in lower extremity europathy at rates similar to other lithotomy based procedures described in the literature.