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Updated: Sep 10, 2025
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Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
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Risk Factors of Positional Peripheral Nerve Injury in Robotic Laparoscopic Radical Prostatectomy
Şenay Göksu1, Gülşah Karaören2, Ahmet Tahra3
1Anaesthesiology and Reanimation Department, Health Science University, Umraniye Training and Research Hospital, Istanbul, Turkey. (Drs. Göksu and Bakan).
JSLS : Journal of the Society of Laparoendoscopic Surgeons
|August 27, 2025
Summary
Robot-assisted laparoscopic radical prostatectomy (RARP) carries a risk of postoperative positional peripheral nerve injury (PPPNI). Higher BMI, operative time, and Trendelenburg time are linked to increased PPPNI incidence.
Area of Science:
- Anesthesiology
- Neurosurgery
- Surgical Patient Safety
Background:
- Maintaining patient positioning during surgery is crucial for anesthesiologists.
- Steep-Trendelenburg-lithotomy positioning in robot-assisted laparoscopic radical prostatectomy (RARP) can lead to postoperative positional peripheral nerve injuries (PPPNI).
Purpose of the Study:
- To determine the incidence and risk factors of PPPNI in RARP patients.
- To identify the most common types and duration of PPPNI following RARP.
Main Methods:
- Retrospective evaluation of 868 RARP patients over 7 years.
- Exclusion of patients with pre-existing peripheral neuropathy.
- Collection of demographic data, ASA score, BMI, CCI, operative time (OT), and Trendelenburg time (TT).
Main Results:
- PPPNI occurred in 5.6% of patients.
- Higher BMI, OT, and TT were significantly associated with PPPNI (P < .01).
- Injuries included upper extremity (55.1%) and lower extremity (51%) issues, with pain and motor deficits being common.
Conclusions:
- RARP is associated with an increased risk of PPPNI.
- Prolonged operative time, Trendelenburg time, and high BMI are key risk factors.
- Patient safety protocols should address these identified risks.
