Patient‐reported extremity symptoms after robot‐assisted laparoscopic cystectomy

Abstract

Aims and objectives To describe patient‐reported extremity symptoms after robot‐assisted laparoscopic cystectomy in patients with bladder cancer. Background Preventive activities for remaining patient safety due to correct positioning play an important part in perioperative nursing care.Extremity injuries are well‐known after prolonged surgery, especially in robot‐assisted urologic surgery in the steep Trendelenburg position. The risk of injury increases due to patient‐related and operative risk factors. Methods A quantitative prospective observational study was conducted. Patients were followed up with the QuickDASH (Disabilities in the Arm, Shoulder and Hand), Lower Extremity Functional Scale (LEFS) and a study‐specific questionnaire 7–10 days and monthly, up to six months after surgery in patients with extremity symptoms. The study adheres to STROBE (strengthening the reporting of observational studies in epidemiology) guidelines, see Supporting information File S1. Results Out of the 94 included participants, 46.8% (n = 44) experienced extremity symptoms 7–10 days after surgery. Pain, numbness and weakness were the most frequent symptoms. There was a discrepancy between the patients reported symptoms and the documentation in the patient records. Only 13.6% (n = 3) of the reported pain was documented, respectively 27.5% (n = 11) of other symptoms. Conclusion A large proportion of the patients report postoperative extremity symptoms after robot‐assisted laparoscopic cystectomy. Prevention of complications in the perioperative setting, are together with follow‐ups, important nursing activities for maintaining patient safety and may both prevent and detect postoperative extremity symptoms and injuries. Relevance to clinical practice This study reveals the need of accurate documentation regarding extremity symptoms in digital patient records, as well as continuous follow‐ups during the hospital stay and after hospital discharge to enable detection of treatable extremity injuries. The result of this study also indicates the importance of nursing activities such as evidence‐based positioning guidelines in the operating theatre for optimal positioning.

Development of Upper Extremity Complex Regional Pain Syndrome After Prolonged Surgery in Lithotomy Position: A Case Report

“…Intraoperative brachial plexus injury risk is increased in patients positioned with arms extended, preexisting peripheral neuropathy, a congenital cervical rib, high or low BMI, and a history of smoking or alcohol abuse. 10 Our patient’s BMI and prolonged surgery increased his risk for perioperative neuropathy. The carpal tunnel syndrome treatment performed before his pain medicine referral may have confounded or contributed to the patient’s CRPS.…”

“…A systematic review of intraoperative peripheral nerve injury with lithotomy for robotic surgery found that preventative measures to stop patients from sliding on operating tables are rarely recorded, thus making it difficult to make recommendations for preventing neuropathy. 10 In our case, documentation simply stated the patient’s arms were tucked with pressure points padded. The American Society of Anesthesiologists taskforce guidelines to prevent perioperative neuropathies discusses reports of brachial and ulnar neuropathies in patients with extremes in body weight, along with a case report of temporary median nerve weakness from elbow overextension.…”