Risk Factors of Positional Peripheral Nerve Injury in Robotic Laparoscopic Radical Prostatectomy

One of the responsibilities of the anesthesiologist is to maintain the physiologic anatomic position during surgery. Postoperative positional peripheral nerve injury (PPPNI) inevitably may occur during robot-assisted laparoscopic radical prostatectomy (RARP) in steep-Trendelenburg-lithotomy positioning. The primary aim of the study was to identify incidence and risk factors for the development of PPPNI in the RARP and the secondary aim was to identify the most common types and duration of PPPNI.

After ethics committee and patients approval, patients who underwent RARP in past 7 years were retrospectively evaluated. Patients with known peripheral neuropathy were excluded. Patient demographics, American Society of Anesthesiologists (ASA) score, body mass index (BMI), Charlson comorbidity index (CCI), operative time (OT), and Trendelenburg time (TT) were obtained from the records. Patients were asked if they had PPPNI and other descriptive questions.

A total of 868 patients were included in the study. The mean age, BMI, ASA risk score, and CCI were 63.44 ± 6.68 years, 27.46 ± 2.75 kg/m², 1.76 ± 0.62, and 2.41 ± 0.89, respectively. PPPNI rate was 5.6% (49 patients). The mean OT, TT and recovery time were 168.83 ± 52.1 minutes, 110.74 ± 46.33 minutes, and 6.5 ± 2.81 months, respectively. The BMI, OT, and TT values of patients with PPPNI were significantly higher than those of patients without PPPNI (P < .01). The cutoff values were 29, 212, and 157 minutes, respectively. Of the 49 patients with PPPNI, 55.1% had upper extremity injuries (pain 51.9%), 51% had lower extremity injuries (motor deficit 58.3%), and 6.1% had injuries to both. Six patients claimed PPPNI.

The RARP is associated with an elevated risk of PPPNIs, particularly in cases of prolonged OT, TT, and high BMI.