Unilateral compartment syndrome of the lower limbs after robotic radical cystectomy and ileal conduit

Singh, Dipika; Chaudhari, AvinashB; Dhodi, JagrutiD

doi:10.4103/ija.ija_63_21

Cited by 1 publication

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“…In accordance to this study, several studies underscored the influence of the operative duration on the occurrence of a compartment syndrome, and surgeons should be aware of a higher risk in procedures lasting more than 4 h. 13,14 This fact is underlined by a multicentre study of the International Radical Cystectomy Consortium (IRCC) as well as two case reports describing the occurrence of compartment syndrome after robot assisted radical cystectomy, a technically challenging procedure in steep Trendelenburg position that often lasts more than 6 h. The authors discuss the type of leg holder during the intervention, long duration of surgery and preexisting PAD as main risk factors for the compartment syndrome post RC. [15][16][17] In our analysis, console time was not statistically significant associated with hypoxemia of the lower limbs. Scrutinized by time point of surgery, we found 25% of events occurring during the first 42 min, 50% in 75 min, 75% in 105 min and 100% in 270 min.…”

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confidence: 57%

Hypoxemia of the lower limbs during robot‐assisted radical prostatectomy in Trendelenburg position

Haeuser,

Münker,

Frey

et al. 2023

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ObjectivesThe objective of this study is to assess frequency and risk factors for intraoperative hypoxemia of the lower limbs during robot‐assisted radical prostatectomy (RARP). Trendelenburg position during RARP may contribute to hypoxemia and compartment syndrome (CS) of the lower limbs as a major but rare complication.Patients and methodsThis prospective study included patients undergoing RARP for prostate cancer. Preoperative calculation of the ankle‐brachial‐index (ABI) was performed. Peripheral oxygen saturation (SpO2) at the toes was routinely measured. Occurrence of SpO2 levels of <90% was defined as hypoxemic events and treated immediately. Blood pressure, intraabdominal pressure, SpO2 of the upper limb and surgery time were monitored in case of hypoxemia. A multivariable logistic regression model was performed with age, BMI, nicotine abuse, MAP, comorbidities as covariates and hypoxemia of the lower limbs as the outcome.ResultsA total of 207 patients were included. Among these, 126 patients had ABI measurements with 10.6% having an abnormal ABI value. One, two or at least three events of lower limb hypoxemia occurred intraoperatively in 19.7%, 14.8% and 16.9%, respectively. In 20 events, surgical instruments were affecting vascular perfusion by compression. None of the covariates were statistically significant associated with lower limb hypoxemia. No patient developed a compartment syndrome.ConclusionDecrease in oxygen saturation of the lower extremities was observed frequently during RARP, without revealing any risk factors for its occurrence. Routine oximetry leads to an early detection of hypoxemia of the lower extremities, giving the anaesthesiologist and surgeon the opportunity to make adequate adjustments (increasing blood pressure and ending iliac vessel compression).

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