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Related Concept Videos

Spinal Nerves: Plexus I01:22

Spinal Nerves: Plexus I

Nerve plexuses are networks of interlacing nerves that serve as communication hubs to distribute and organize nerve action across various body regions. The nerve plexuses are organized into the cervical plexus located in the neck region, brachial plexus in the shoulder area, lumbar plexus found in the lower back, sacral plexus situated in the pelvis, and coccygeal plexus located in the coccygeal region.
The Cervical Plexus
The cervical plexus, formed by the anterior rami of the first four...

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Retzius-Sparing Robot-Assisted Radical Prostatectomy
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Upper and middle trunk brachial plexopathy after robotic prostatectomy.

Jagan Devarajan1, J Bryant Byrd, Michael C Gong

  • 1Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.

Anesthesia and Analgesia
|July 17, 2012
PubMed
Summary

Robotic-assisted prostatectomy can cause brachial plexus injury, particularly to the upper and middle trunks, due to patient positioning. Alternative methods to shoulder restraints are recommended to prevent this nerve damage.

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Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Robotic Surgery

Background:

  • Robotic-assisted prostatectomy often requires steep head-down tilt positioning.
  • Patient positioning strategies, including shoulder immobilization, are crucial for surgical access and stability.

Observation:

  • Three patients developed left arm upper and middle trunk brachial plexopathies post-robotic-assisted prostatectomy.
  • Surgical positioning involved steep head-down tilt, shoulder beanbag restraints, and asymmetrical arm positioning (left arm abducted 90°, right arm adducted).

Findings:

  • The combination of steep head-down tilt, shoulder immobilization, and arm abduction can create injurious forces on the brachial plexus.
  • Mechanisms include cephalad torso slide relative to an abducted arm and impeded shoulder girdle compensation due to restraints, leading to nerve stretching and compression.

Implications:

  • Clinicians should be aware of the risk of brachial plexus injury during robotic prostatectomy with steep head-down positioning.
  • Consider alternative methods to shoulder restraints, such as tucking both arms, to mitigate brachial plexus stretching and compression risks.