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Fleisch MC, Bader W, Balzer K, Bennefeld L, Boeing C, Bremerich D, Gass P, Geissbuehler V, Koch MC, Nothacker MJ, Pietzner K, Renner SP, Römer T, Roth S, Schütz F, Schulte-Mattler W, Sehouli J, Lippach K, Tamussino K, Teichmann A, Tempfer C, Thill M, Tinneberg HR, Zarras K. The Prevention of Positioning Injuries During Gynecologic Surgery. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/077, October 2020). Geburtshilfe Frauenheilkd 2021; 81:447-468. [PMID: 33867563 DOI: 10.1055/a-1378-4209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 10/21/2022] Open
Abstract
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.
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Affiliation(s)
- Markus C Fleisch
- Landesfrauenklinik, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Werner Bader
- Zentrum für Frauenheilkunde, Klinikum Bielefeld Mitte, Bielefeld, Germany
| | - Kai Balzer
- Klinik für Gefäßchirurgie, GFO Kliniken, Bonn, Germany
| | - Luisa Bennefeld
- Landesfrauenklinik, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Carsten Boeing
- Klinik für Gynäkologie und Geburtshilfe, AMEOS Klinikum St. Clemens Oberhausen, Oberhausen, Germany
| | | | | | | | - Martin C Koch
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Monika J Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Universität Marburg, Marburg, Germany
| | - Klaus Pietzner
- Charité Frauenklinik, Universitätsmedizin Berlin, Berlin, Germany
| | | | - Thomas Römer
- Frauenklinik, Evangelisches Krankenhaus Weyertal, Köln, Germany
| | - Stephan Roth
- Klinik für Urologie, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | | | - Jalid Sehouli
- Charité Frauenklinik, Universitätsmedizin Berlin, Berlin, Germany
| | - Kristina Lippach
- Pflegewissenschaften und Praxisentwicklung, LMU München, München, Germany
| | - Karl Tamussino
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Graz, Graz, Austria
| | - Alexander Teichmann
- Sichuan Center for Gynaecology and Breast Surgery, Dept. of Perinatal Medicine, Medical University of Southwest China, Luzhou (Sichuan), China
| | - Clemens Tempfer
- Klinik für Frauenheilkunde und Geburtshilfe, Marienhospital Herne, Universitätsklinikum Bochum, Bochum/Herne, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | | | - Konstantinos Zarras
- Abteilung für Allgemein-, Viszeral- und Minimalinvasive Chirurgie des VVKD Marienhospitals Düsseldorf, Düsseldorf, Germany
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Gelder C, McCallum AL, Macfarlane AJR, Anderson JH. A systematic review of mechanical thromboprophylaxis in the lithotomy position. Surgeon 2018; 16:365-371. [PMID: 29699782 DOI: 10.1016/j.surge.2018.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/22/2018] [Accepted: 03/06/2018] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Chloé Gelder
- Department of Surgery, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
| | - Audrey L McCallum
- Department of Surgery, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.
| | - Alan J R Macfarlane
- Department of Anaesthesia, Pain and Critical Care Medicine, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.
| | - John H Anderson
- Department of Surgery, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.
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Clinical Issues-January 2018. AORN J 2018; 107:132-141. [DOI: 10.1002/aorn.12009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Hefler-Frischmuth K, Lafleur J, Brunnmayr-Petkin G, Roithmeier F, Unterrichter V, Hefler L, Tempfer C. Compartment syndrome after gynecologic laparoscopy: systematic review of the literature and establishment of normal values for postoperative serum creatine kinase and myoglobin levels. Arch Gynecol Obstet 2017. [DOI: 10.1007/s00404-017-4440-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mangham M. Positioning of the anaesthetised patient during robotically assisted laparoscopic surgery: perioperative staff experiences. J Perioper Pract 2016; 26:50-52. [PMID: 27149834 DOI: 10.1177/175045891602600305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
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.
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Kikuchi T, Maeda H. Two cases of compartment syndrome of the lower extremities during surgery for gynecological malignancies. J Anesth 2016; 30:481-5. [DOI: 10.1007/s00540-015-2135-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
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Fleisch MC, Bremerich D, Schulte-Mattler W, Tannen A, Teichmann AT, Bader W, Balzer K, Renner SP, Römer T, Roth S, Schütz F, Thill M, Tinneberg H, Zarras K. The Prevention of Positioning Injuries during Gynecologic Operations. Guideline of DGGG (S1-Level, AWMF Registry No. 015/077, February 2015). Geburtshilfe Frauenheilkd 2015; 75:792-807. [PMID: 26365999 PMCID: PMC4554497 DOI: 10.1055/s-0035-1557776] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
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.
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Affiliation(s)
| | - D. Bremerich
- Klinik für Anästhesiologie, Agaplesion Markus Krankenhaus Frankfurt am Main, Frankfurt am Main
| | - W. Schulte-Mattler
- Klinik und Poliklinik für Neurologie Universitätsklinikum Regensburg, Regensburg
| | - A. Tannen
- Institut für Gesundheits- und Pflegewissenschaften, Charité Universitätsmedizin Berlin, Berlin
| | | | - W. Bader
- Zentrum für Frauenheilkunde, Klinikum Bielefeld Mitte, Bielefeld
| | - K. Balzer
- Gefäß- und Endovaskulärchirurgie, GFO Kliniken Bonn, Betriebsstätte St. Marien, Bonn
| | - S. P. Renner
- Universitätsklinikum Erlangen-Nürnberg, Frauenklinik, Erlangen
| | - T. Römer
- Klinik für Gynäkologie und Geburtshilfe, Evangelisches Krankenhaus, Cologne
| | - S. Roth
- Urologische Klinik, Helios Klinikum Wuppertal, Wuppertal
| | - F. Schütz
- Allgemeine Frauenheilkunde und Geburtshilfe, Universitätsklinikum Heidelberg, Heidelberg
| | - M. Thill
- Klinik für Gynäkologie, Agaplesion Markus Krankenhaus, Frankfurt am Main
| | - H. Tinneberg
- Zentrum für Frauenheilkunde und Geburtshilfe, Universitätsklinium Gießen, Gießen
| | - K. Zarras
- Abteilung für Allgemein-, Viszeral- und Minimalinvasive Chirurgie, Marienhospital Düsseldorf, Düsseldorf
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Marchesi M, Marchesi A, Calori GM, Cireni LV, Sileo G, Merzagora I, Zoia R, Vaienti L, Morini O. A sneaky surgical emergency: Acute compartment syndrome. Retrospective analysis of 66 closed claims, medico-legal pitfalls and damages evaluation. Injury 2014; 45 Suppl 6:S16-20. [PMID: 25457313 DOI: 10.1016/j.injury.2014.10.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- M Marchesi
- Università degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni, Italy.
| | - A Marchesi
- Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Italy.
| | - G M Calori
- Orthopaedic Reparative Surgery Department, Orthopaedic Institute Gaetano Pini, University of Milan, Italy.
| | - L V Cireni
- Vascular Surgery Service, Istituto Auxologico Italiano, Italy.
| | - G Sileo
- Dipartimento di Medicina Sperimentale, Università degli Studi di Milano-Bicocca, Italy.
| | - I Merzagora
- Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni, Italy.
| | - R Zoia
- Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni, Italy.
| | - L Vaienti
- Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Italy.
| | - O Morini
- Dipartimento di Medicina Sperimentale - Cattedra di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano-Bicocca, Italy.
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Bauer EC, Koch N, Janni W, Bender HG, Fleisch MC. Compartment syndrome after gynecologic operations: evidence from case reports and reviews. Eur J Obstet Gynecol Reprod Biol 2014; 173:7-12. [DOI: 10.1016/j.ejogrb.2013.10.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 10/10/2013] [Accepted: 10/31/2013] [Indexed: 11/26/2022]
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