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Lower extremity neuropathies after robot-assisted laparoscopic prostatectomy on a split-leg table.
Gökhan Koç1, Ngii N Tazeh, Fadi N Joudi
1Department of Urology, University of Iowa, Iowa City, Iowa 52242-1089, USA.
Journal of Endourology
|April 21, 2012
Summary
Robot-assisted prostatectomy using split-leg positioning had a low incidence of neuropathy. Prolonged intraoperative time was identified as a risk factor for nerve injury, potentially affecting the femoral nerve.
Area of Science:
- Urology
- Neurosurgery
- Surgical Safety
Background:
- Lower extremity neuropathies are a known risk associated with prolonged lithotomy positioning during surgery.
- Robot-assisted laparoscopic prostatectomy (RALP) programs often utilize specialized tables to mitigate positioning risks.
Purpose of the Study:
- To determine the incidence of lower extremity neuropathies in patients undergoing RALP with split-leg positioning.
- To identify patient and surgical variables associated with these neuropathies.
Main Methods:
- Retrospective review of 377 patients who underwent RALP using a split-leg table.
- Analysis of patient demographics (height, weight, BMI, age, smoking status) and surgical variables (surgeon experience, intraoperative time).
- Intraoperative time defined as anesthesia induction to emergence.
Main Results:
- A 1.3% incidence of lower extremity neuropathies was observed in the immediate postoperative period.
- Increased intraoperative time was the only significant risk factor identified (496.2 ± 34.8 min vs 366.3 ± 96.1 min, P<0.001).
- Three patients experienced symptoms suggestive of femoral mononeuropathy.
Conclusions:
- Intraoperative time is a significant risk factor for postoperative neuropathy following RALP with split-leg positioning.
- Split-leg positioning may pose a risk to the femoral nerve, unlike the common peroneal nerve typically affected by lithotomy positioning.
