Positioning injuries associated with robotic assisted urological surgery

Area of Science:

• Urology
• Neurosurgery
• Surgical Safety

Background:

• Nerve injuries from patient positioning are a known surgical complication.
• Robotic surgery introduces novel positioning challenges and necessitates patient safety vigilance.
• Data on positioning injury incidence in robotic urological surgery is limited.

Purpose of the Study:

• To determine the incidence of patient positioning injuries during robotic-assisted urological surgery.
• To identify specific risk factors associated with these injuries.
• To describe the temporal resolution of neurological deficits resulting from positioning injuries.

Main Methods:

• Retrospective review of adult urological cases utilizing da Vinci® Si and Standard® Surgical Systems (January 2010 - December 2011).
• Risk factors categorized into positioning, operative, patient-specific, and anesthesia-related domains.
• Analysis of 13 specific patient care aspects for association with positioning injuries.

Main Results:

• 22 positioning injuries (6.6%) occurred in 334 operations.
• Injuries resolved within 1 month (59.1%), 1-6 months (18.2%), or persisted beyond 6 months (22.7%).
• Significant risk factors included operative time (p <0.0001), in-room time (p <0.0001), and American Society of Anesthesiologists (ASA) class (p = 0.0033).

Conclusions:

• Positioning injuries are under-recognized in robotic urological surgery and can have prolonged resolution.
• Patient counseling regarding positioning injury risks is crucial, particularly for lengthy procedures.
• Patients with multiple comorbidities (e.g., ASA class 4) face elevated risk for these injuries.