Patient positioning during minimally invasive surgery: what is current best practice?

Area of Science:

• Surgical Complications
• Patient Safety
• Minimally Invasive Surgery

Background:

• Positioning injuries are a recognized surgical complication with potential for significant patient morbidity.
• Neurovascular injuries are associated with minimally invasive surgery due to patient and case-specific factors.
• A literature review was conducted to understand the pathophysiology and provide practical recommendations for positioning injuries.

Purpose of the Study:

• To review the available literature on the pathophysiology of positioning injuries.
• To provide practical recommendations for the prevention of positioning injuries in minimally invasive surgery.
• To highlight the importance of addressing modifiable risk factors and team awareness.

Main Methods:

• A comprehensive literature search was performed.
• Studies were categorized by level of evidence, prioritizing prospective studies.
• 14 studies were analyzed to summarize findings related to positioning injuries.

Main Results:

• The incidence of positioning injuries in prospective populations can be as high as one-third, with a true post-operative prevalence estimated at 2-5%.
• The primary mechanism involves intraneural disruption from stretching or pressure, leading to decreased perfusion, ischemia, and potentially rhabdomyolysis.
• Prevention strategies include managing modifiable patient factors (e.g., BMI), using appropriate positioning devices, and maintaining intraoperative team awareness through extremity checks and time management.

Conclusions:

• The risk of positioning injuries during minimally invasive surgery is often underestimated.
• Surgeons must counsel patients on the potential for these complications.
• Operative teams should proactively implement strategies to mitigate identified risk factors.