Measuring Contact Pressure of Lower Extremities in Patients Undergoing Robot-Assisted Radical Prostatectomy

Lower extremity neuropathy (LEN) is a well-recognized complication that arises during robotic surgeries in lithotomy-Trendelenburg position (L-T position). It is caused by persistent compression to the nerves. Our aim was to investigate the levels of compression to the nerves by measuring the contact pressure of the lower extremities in men undergoing robot-assisted radical prostatectomy (RARP).

A total of 138 patients undergoing RARP were enrolled prospectively. The contact pressure of the lower extremities was measured using a portable contact pressure measurement device (Cello®, Cape Co., Kanagawa, Japan) in lithotomy position (L position) and L-T position preoperatively, and in L position postoperatively. Patient positioning was readjusted when the preoperative contact pressure was over 32 mm Hg. The contact pressure was compared between pre- and postoperative values.

A total of 33 patients (23.9%) needed readjustment of positioning due to high contact pressure. No one developed LEN. The contact pressure in the L position significantly increased postoperatively (right: 21.4 mm Hg, p < 0.0001; left: 18.6 mm Hg, p = 0.0011). A high body mass index (BMI) was associated with a postoperative increment of pressure in the L position.

The contact pressure of the lower extremities increased after RARP and the increase was correlated with BMI.