Lower Extremity Compartment Syndrome after Laparoscopic Radical Hysterectomy: Brief Report of an Unusual Complication of Laparoscopic Positioning Requirements

The Prevention of Positioning Injuries During Gynecologic Surgery. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/077, October 2020)

Purpose Positioning injuries are relatively common, forensically highly relevant complications of gynecologic surgery. The aim of this official AWMF S2k-guideline is to provide statements and recommendations on how to prevent positioning injuries using the currently available literature. The literature was evaluated by an interdisciplinary group of experts from professional medical societies. The consensus on recommendations and statements was achieved in a structured consensus process. Method The current guideline is based on the expired S1-guideline, which was updated by a systematic search of the literature and a review of relevant publications issued between February 2014 and March 2019. Statements were compiled and voted on by a panel of experts. Recommendations The guideline provides general and specific recommendations on the prevention, diagnosis and treatment of positioning injuries.

A systematic review of mechanical thromboprophylaxis in the lithotomy position

BACKGROUND

Venous thrombosis and compartment syndrome are potentially serious complications of prolonged, lithotomy position surgery. It is unclear whether mechanical thromboprophylaxis in this group of patients modifies the risk of compartment syndrome. This qualitative systematic review examines the evidence base to guide clinical practice.

METHOD

A systematic review was performed guided by Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) criteria, to identify studies reporting relationships between lithotomy position, compartment syndrome and mechanical thromboprophylaxis. The aim was to determine if mechanical thromboprophylaxis influenced compartment syndrome risk in the lithotomy position.

RESULTS

Sixteen studies were identified: eight case reports or case series (12 patients), two completed audit cycles (approximately 2000 patients), four reviews and two volunteer case control studies (33 subjects). There were no randomised studies. Nine studies associated mechanical thromboprophylaxis with compartment syndrome risk but in each case a causative relationship was speculative. In contrast, five papers, including an experimental, cohort study and two observational, population studies recommended intermittent pneumatic compression as prevention against compartment syndrome in lithotomy position. One review and one case report were unable to make a recommendation.

CONCLUSIONS

The level of evidence addressing the interaction between the lithotomy position, compartment syndrome and mechanical thromboprophylaxis is weak. There is no conclusive evidence that mechanical thromboprophylaxis causes compartment syndrome in the lithotomy position. There is limited evidence to suggest intermittent pneumatic compression may be a safe method of mechanical thromboprophylaxis if accompanied by strict adherence to other measures to reduce the chance of compartment syndrome. However further studies are required.

Positioning of the anaesthetised patient during robotically assisted laparoscopic surgery: perioperative staff experiences

Safe, patient centred care is a large part of our trust values at the Royal Wolverhampton NHS Trust. Robotic assisted laparoscopic surgery (RALS) is still in its infancy within our trust, and we decided to look at what we have learned so far regarding patient positioning during robotic surgery for gynae-oncology and uro-gynae procedures. We also considered what we believe needs to be achieved in order to deliver high standards of care in positioning patients during robotic surgery, not only now, but also for the future of robotic surgery.

The Prevention of Positioning Injuries during Gynecologic Operations. Guideline of DGGG (S1-Level, AWMF Registry No. 015/077, February 2015)

Purpose: Official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). Positioning injuries after lengthy gynecological procedures are rare, but the associated complications can be potentially serious for patients. Moreover, such injuries often lead to claims of malpractice and negligence requiring detailed medical investigation. To date, there are no binding evidence-based recommendations for the prevention of such injuries. Methods: This S1-guideline is the work of an interdisciplinary group of experts from a range of different professions who were commissioned by DGGG to carry out a systematic literature search of positioning injuries. Members of the participating scientific societies develop a consensus in an informal procedure. Afterwards the directorate of the scientific society approves the consensus. The recommendations cover.

A sneaky surgical emergency: Acute compartment syndrome. Retrospective analysis of 66 closed claims, medico-legal pitfalls and damages evaluation

BACKGROUND

Acute compartment syndrome (ACS) is a clinical condition with potentially dramatic consequences, therefore, it is important to recognise and treat it early. Good management of ACS minimises or avoids the sequelae associated with a late diagnosis, and may also reduce the risk of malpractice claims. The aim of this article was to evaluate different errors ascribed to the surgeon and to identify how the damage was evaluated.

MATERIALS AND METHODS

A total of 66 completed and closed ACS cases were selected. The following were analysed for each case: clinical management before and after diagnosis of ACS, imputed errors, professional fault, damage evaluation and quantification. Particular attention was paid to distinguishing between impairment because of primary injury and iatrogenic impairment. Statistical analyses were performed using Fisher's exact test and Pearson's correlation.

RESULTS

The most common presenting symptom was pain. Delay in the diagnosis, and hence delay in decompression, was common in the study. A total of 48 out of 66 cases resolved with the verdict of iatrogenic damage, which varied from 12% to 75% of global capability of the person. A total of $394,780 out of $574,680 (average payment) derived from a medical error.

CONCLUSIONS

ACS is a clinical emergency that requires continuous clinical surveillance from both medical and nursing staff. The related damage should be evaluated in two parts: damage deriving from the trauma, so that it is considered inevitable and independent from the surgeon's conduct, and damage deriving from a surgeon's error, which is eligible for an indemnity payment.