Neurologic injury and patient displacement in gynecologic laparoscopic surgery using a beanbag and shoulder supports

Treszezamsky, Alejandro D.; Fenske, S.S.; Moshier, Erin; Ascher‐Walsh, Charles

doi:10.1002/ijgo.12325

Cited by 11 publications

(5 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Removing the small intestine from the pelvic cavity is important to obtain a clear view and to avoid inadvertent contact with the intestine during surgery. However, the steep Trendelenburg position has been reported to be associated with complications such as gas embolism, 1 increased intraocular pressure, [2][3][4] increased intracranial pressure, 5,6 decreased blood flow in the internal carotid artery, 7 spontaneous otorrhea, 8 upper-body complications, 9 nerve injury, 10,11 peripheral neuropathy, 12 venous thromboembolism, 13,14 and lower-extremity compartment syndrome caused by impaired blood flow. 15 Gould et al previously reported that a mean Trendelenburg angle of 28.0 was required to complete robotic gynecologic surgery.…”

Section: Introductionmentioning

confidence: 99%

Factors related to clearance of the small pelvic cavity during gynecologic laparoscopic surgery

Hiraishi,

Kitahara,

Kobayashi

et al. 2024

J of Obstet and Gynaecol

View full text Add to dashboard Cite

AimTo identify factors influencing the Trendelenburg angle required during laparoscopic gynecological surgery.MethodsPatients who underwent laparoscopic surgery at a single university hospital between May 1, 2019, and March 31, 2021 were enrolled. Data were extracted from the medical records, while magnetic resonance imaging scans and all laparoscopic surgery videos were retrospectively reviewed to assess the presence of the small intestine in the pelvic cavity as well as the adhesions at each site. Groups with and without the small intestine in the pelvic cavity, and those requiring a Trendelenburg angle above or below 13° were compared.ResultsIn total, 219 patients were examined. The Trendelenburg angle was significantly higher (p = 0.004), while a significant increase in ovarian adhesions was observed (p = 0.033; odds ratio [OR], 2.30; 95% confidence interval [CI], 1.05–5.01) in the group without the presence of the small intestine in the pelvic cavity. Furthermore, the group requiring a Trendelenburg angle of ≥13° had significantly thicker subcutaneous fat (p = 0.044) and more ileal adhesions (p = 0.040, OR, 1.82; 95% CI, 1.03–3.23) than the group with an angle of <13°.ConclusionCases of ileal adhesions or thick subcutaneous fat are more likely to require a Trendelenburg angle of ≥13°. Therefore, Trendelenburg complications should be considered in this group. In addition, ovarian adhesions make it more difficult to exclude the small intestine from the small pelvic cavity, and may be associated with endometriosis.

show abstract

Section: Introductionmentioning

confidence: 99%

Factors related to clearance of the small pelvic cavity during gynecologic laparoscopic surgery

Hiraishi,

Kitahara,

Kobayashi

et al. 2024

J of Obstet and Gynaecol

View full text Add to dashboard Cite

show abstract

“…Al-Temimi et al (2017) mentioned that the Trendelenburg position may increase the risk of upper limb neuropathy. In our review of the literature, only two studies were found that measured the time spent in this position (Klauschie et al, 2010; Treszezamsky et al, 2017). Both studies concluded that patient displacement on the surgical table was not influenced by the time in the Trendelenburg position and that this factor was not identified as a risk factor for the development of PNI.…”

Section: Discussionmentioning

confidence: 99%

“…Data were gathered preoperatively on patient-related variables (Abdalmageed et al, 2017;Al-Temimi et al, 2017;Welch, 2017), including age, gender, perioperative American Society of Anesthesiologists risk, BMI, specialty in charge, and category of diagnosis. Data were gathered intraoperatively on perioperative variables, including type of intervention, the use of conventional compression stockings or intermittent pneumatic compression (Güzelküçük et al, 2014;Kim et al, 2016), the use of Allen shoulder supports, total duration of the surgical intervention, and time in minutes (Bohrer et al, 2009) spent in the Trendelenburg position (Treszezamsky et al, 2017) and in the left or right lateral positions.…”

Section: Methodsmentioning

confidence: 99%

Factors Associated With Peripheral Nerve Injury After Pelvic Laparoscopy: The Importance of Surgical Positioning

Campo

Marias

Macias

et al. 2022

Journal of Nursing Research

View full text Add to dashboard Cite

Background: Nerve damage after abdominal and pelvic surgery is rare but potentially serious. The incidence of peripheral nerve injury is difficult to assess, and rates of between 0.02% and 21% have been cited in the literature. Signs and symptoms of this type of injury may appear immediately after surgery or a few days later.Purpose: This study was developed to assess the rate of peripheral nerve injury after pelvic laparoscopy and to identify associated risk factors.Methods: A pilot prospective cohort study was conducted between March 2018 and April 2019 on 101 patients with a 1-month follow-up using two semistructured clinical interviews. We carried out a descriptive analysis followed by univariable and multivariable logistic regression analyses.Results: Thirteen patients were found to have peripheral nerve injuries, representing a rate of 12.9%. Overall, 14 injuries (five severe and nine mild) were detected. One patient had two mild injuries. In this study, the risk of injury was found to increase 1.77-fold (OR = 1.77, 95% CI [1.13, 2.76], p = .007) for each hour the patient was in the Trendelenburg position.Conclusions/Implications for Practice: The longer the patient is in the Trendelenburg position, the greater the risk of peripheral nerve damage. Patients aged 60 years or less also face a higher risk of nerve injury.

show abstract

“…It was shown that intraocular pressure increases in steep Trendelenburg resulting in the potential for ocular complications such as corneal abrasion and ischemic optic neuropathy [32][33][34]. Intraoperative peripheral nerve injuries are rare, but occasionally serious when related to lithotomy positioning with steep Trendelenburg [35][36][37]. Therefore, instead of using constant steep TIA and high PP pairs in laparoscopic procedures, they should be adjusted individually for each case to an extent where the operative field is adequate to proceed safely with the planned operation.…”

Section: An Objective Visual Indexing Based On Anatomical Landmarksmentioning

confidence: 99%

Mechanical bowel preparation prior to gynaecological laparoscopy enables better operative field visualization, lower pneumoperitoneum pressure and Trendelenburg angle during the surgery: a perspective that may add to patient safety

Kalkan¹,

Yassa²,

Bakay³

et al. 2021

Clin. Exp. Obstet. Gynecol.

View full text Add to dashboard Cite

Background: To find the effects of mechanical bowel preparation (MBP) on operative field visualization, and to measure pneumoperitoneum pressure (PP) and Trendelenburg inclination angle (TIA) values. Methods: In this two-centred, randomised, single-blind and controlled study, 90 patients who underwent laparoscopic gynaecological surgery for benign conditions were included. After the exclusions, 44 patients received MBP with oral sodium phosphate enema (study group) and 42 did not receive bowel preparation or underwent diet restrictions (control group). An objective visual index, PP and TIA were measured in a stepwise design of assessments. Results: The Visual Index at first inspection right after establishing a 12 mmHg PP and a standard 30 • TIA was found to be significantly in favour of the study group (p = 0.015). The lowest reached TIA in standard 12 mmHg PP following stepwise decrease was observed as 15.2 • and 25 • in the study and control groups, respectively (p < 0.001). The lowest reached PP was 8.9 mmHg and 11.9 mmHg in the study and control groups, respectively (p < 0.001). Patients who received MBP reported significantly higher levels of negative discomfort measures (p < 0.032), however 80% of those reported MBP as acceptable. Conclusion: Significantly better operative field visualization, lower TIA and PP was achieved with MBP. MBP enabled a decrement of either 10 • in TIA or 3 mmHg in PP with an adequate operative field to proceed safely for the benign gynaecological laparoscopic operations in exchange for acceptable discomfort for the patients.

show abstract

Neurologic injury and patient displacement in gynecologic laparoscopic surgery using a beanbag and shoulder supports

Cited by 11 publications

References 12 publications

Factors related to clearance of the small pelvic cavity during gynecologic laparoscopic surgery

Factors related to clearance of the small pelvic cavity during gynecologic laparoscopic surgery

Factors Associated With Peripheral Nerve Injury After Pelvic Laparoscopy: The Importance of Surgical Positioning

Mechanical bowel preparation prior to gynaecological laparoscopy enables better operative field visualization, lower pneumoperitoneum pressure and Trendelenburg angle during the surgery: a perspective that may add to patient safety

Contact Info

Product

Resources

About