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Drummond L, McNeill A. Suprascapular nerve injury during robot-assisted radical prostatectomy: a case report. Ann R Coll Surg Engl 2025; 107:83-84. [PMID: 36748792 DOI: 10.1308/rcsann.2022.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
This case report aims to encourage teams to readjust the operating table during prolonged robotic cases, especially in those patients with a high body mass index. We present the case of a 59-year-old male who developed neuropathic pain involving the suprascapular nerve distribution following a prolonged robotic-assisted radical prostatectomy.
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Grossmann NC, Aschwanden FJ, Cornelius J, Malkmus C, Zahiti L, Viktorin P, Fierley L, Wilder-Smith E, Baumeister P, Mattei A, Fankhauser CD. Impact of patient positioning during surgery on neuropathies after robot-assisted laparoscopic radical prostatectomy: a randomised controlled trial. BJU Int 2024. [PMID: 39668142 DOI: 10.1111/bju.16623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2024]
Abstract
OBJECTIVE To investigate whether ankle braces or shoulder support used for fixation during robot-assisted radical prostatectomy (RARP), where patients are commonly positioned in the head-down Trendelenburg position, differ in their potential to cause peripheral nerve injury. PATIENTS AND METHODS A prospective, double-blind, randomised controlled trial was conducted on patients undergoing RARP for prostate cancer between May 2020 and September 2021 using the da Vinci® Si system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Patients were randomly assigned to either the shoulder or ankle brace fixation group and were positioned in a modified lithotomy position. Neurological examinations were performed pre- and postoperatively. The primary endpoint was the prevalence of any peripheral neuropathy on the first postoperative day. RESULTS A total of 98 patients were treated using the da Vinci Si system: 46 in the lithotomy lower fixation group and 52 in the lithotomy upper fixation group. Both groups mainly recorded neuropathies in the lower extremity, with a total incidence of 6.9% for lower neuropathies and 3.9% for upper neuropathies. All neuropathies were sensory, with one exception in the upper fixation group presenting a motor deficit. Over a median follow-up of 12 months, no neuropathies persisted. Neuropathy on the first postoperative day was observed in 15% of patients in the upper fixation group and 6.5% in the lower fixation group (P = 0.2). CONCLUSION We observed neuropathies in a clinically relevant proportion of men undergoing RARP. We were not able to demonstrate a significant difference regarding postoperative neuropathies between ankle braces or shoulder support during RARP.
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Affiliation(s)
- Nico Christian Grossmann
- Department of Urology, Kantonsspital Luzern, Lucerne, Switzerland
- University of Lucerne, Lucerne, Switzerland
| | | | - Julian Cornelius
- Department of Urology, Kantonsspital Luzern, Lucerne, Switzerland
| | | | - Leutrim Zahiti
- Department of Urology, Kantonsspital Luzern, Lucerne, Switzerland
| | - Pascal Viktorin
- Department of Urology, Kantonsspital Luzern, Lucerne, Switzerland
| | - Lea Fierley
- Department of Urology, Kantonsspital Luzern, Lucerne, Switzerland
| | | | - Philipp Baumeister
- Department of Urology, Kantonsspital Luzern, Lucerne, Switzerland
- University of Lucerne, Lucerne, Switzerland
| | - Agostino Mattei
- Department of Urology, Kantonsspital Luzern, Lucerne, Switzerland
- University of Lucerne, Lucerne, Switzerland
| | - Christian Daniel Fankhauser
- Department of Urology, Kantonsspital Luzern, Lucerne, Switzerland
- University of Lucerne, Lucerne, Switzerland
- University of Zurich, Zurich, Switzerland
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Yamasaki K, Fujii K, Kohjimoto Y, Matsuda K, Iwamoto H, Kawai M, Wan K, Kawamata T. Lower extremity pain and/or numbness after laparoscopic surgery and robot-assisted surgery in the lithotomy position combined with the Trendelenburg position. J Anesth 2024; 38:821-827. [PMID: 39217586 DOI: 10.1007/s00540-024-03399-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 08/17/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE The purpose of this study was to investigate the incidence and risk factors of lower extremity pain and/or numbness after laparoscopic colorectal surgery and robot-assisted laparoscopic radical prostatectomy in the lithotomy position combined with the Trendelenburg position. The relationship between creatine kinase (CK) levels and lower extremity pain and/or numbness was also investigated. METHODS We retrospectively reviewed adult patients who underwent laparoscopic colorectal surgery and robot-assisted laparoscopic radical prostatectomy in the lithotomy position combined with the Trendelenburg position between May 2015 and April 2020. Logistic regression analysis was used to identify risk factors of lower extremity pain and/or numbness. Preoperative and postoperative CK levels were compared in patients with and those without lower extremity pain and/or numbness. RESULTS Among 940 patients, 1.9% experienced lower extremity pain and/or numbness postoperatively. The incidences of lower extremity pain and/or numbness after laparoscopic colorectal surgery and after robot-assisted laparoscopic radical prostatectomy were 1.7% and 2.1%, respectively. Multivariate logistic regression analysis revealed that only duration of surgery > 4 h (odds ratio = 3.144, 95% CI: 1.102-8.969, p = 0.032) was a significant predictor of lower extremity pain and/or numbness. Postoperative median CK level in patients with lower extremity pain and/or numbness was significantly higher than that in patients without lower extremity pain and/or numbness. CONCLUSION The incidence of lower extremity pain and/or numbness after laparoscopic colorectal surgery was comparable to that after robot-assisted laparoscopic radical prostatectomy. Prolonged duration of surgery contributed to lower extremity pain and/or numbness. Significantly elevated CK levels in patients with lower extremity pain and/or numbness suggest the involvement of muscle injury in these symptoms.
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Affiliation(s)
- Keiko Yamasaki
- Department of Anesthesiology, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Keisuke Fujii
- Department of Anesthesiology, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Kenji Matsuda
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiromitsu Iwamoto
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Manabu Kawai
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Ke Wan
- Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan
| | - Tomoyuki Kawamata
- Department of Anesthesiology, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan.
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Ravichandran R, Patton JL, Park H. Electrotactile proprioception training improves finger control accuracy and potential mechanism is proprioceptive recalibration. Sci Rep 2024; 14:26568. [PMID: 39496827 PMCID: PMC11535408 DOI: 10.1038/s41598-024-78063-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 10/28/2024] [Indexed: 11/06/2024] Open
Abstract
This study presents a novel training technique, visual + electrotactile proprioception training (visual + EP training), which provides additional proprioceptive information via tactile channel during motor training to enhance the training effectiveness. In this study, electrotactile proprioception delivers finger aperture distance information in real-time, by mapping frequency of electrical stimulation to finger aperture distance. To test the effect of visual + EP training, twenty-four healthy subjects participated in the experiment of matching finger aperture distance with distance displayed on screen. Subjects were divided to three groups: the first group received visual training and the other two groups received visual + EP training with or without a post-training test with electrotactile proprioception. Finger aperture control error was measured before and after the training (baseline, 15-min post, 24-h post). Experimental data suggest that both training methods decreased finger aperture control error at 15-min post-training. However, at 24-h post-training, the training effect was fully retained only for the subjects who received visual + EP training, while it washed out for the subjects with visual training. Distribution analyses based on Bayesian inference suggest that the most likely mechanism of this long-term retention is proprioceptive recalibration. Such applications of artificially administered sense have the potential to improve motor control accuracy in a variety of applications.
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Affiliation(s)
- Rachen Ravichandran
- Electrical and Computer Engineering, Texas A&M University, College Station, TX, 77843, USA
| | - James L Patton
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, 60607, USA
| | - Hangue Park
- Electrical and Computer Engineering, Texas A&M University, College Station, TX, 77843, USA.
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea.
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, South Korea.
- Department of MetaBioHealth, Sungkyunkwan University, Suwon, South Korea.
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Champion AF, Congiusta AD, Manski AF, Lee JM, Duca A. Does Positioning During Oral and Maxillofacial Surgery Operations Influence the Development of Upper Extremity Peripheral Neuropathy? J Oral Maxillofac Surg 2024; 82:1032-1037. [PMID: 38852610 DOI: 10.1016/j.joms.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/26/2024] [Accepted: 05/19/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Controversy exists regarding the role of specific etiology and mitigating factors in perioperative upper extremity peripheral neuropathy (PUN) development during oral and maxillofacial surgery (OMS) procedures. PURPOSE The purpose of this study was to measure the association between upper extremity (UE) positioning and developing PUN in OMS operations. STUDY DESIGN, SETTING, SAMPLE The investigators implemented a retrospective cohort study. Patients referred to the Department of Oral and Maxillofacial Surgery at Jefferson Health who underwent orthognathic, telegnathic, or free flap surgery from April 2017 through December 2021 were identified. Exclusion criteria were age less than 13, revision surgery, ablative case without free flap reconstruction, incomplete medical record, pre-existing neuropathy, and UE position other than tucked or abducted. PREDICTOR VARIABLE The predictor variable was UE position during surgery, which had 2 levels-tucked or abducted. MAIN OUTCOME VARIABLE The outcome variable was self-reported development of PUN, defined as new sensory and/or motor deficit in a nonoperated extremity diagnosed within 48 hours of surgery. COVARIATES Demographic covariates included age, gender, and race. Perioperative covariates included American Society of Anesthesiologists physical status and body mass index (BMI). The operative covariate was general anesthesia (GA) duration. ANALYSES Descriptive statistics were calculated. Shapiro-Wilk test was used to assess normality of the sample. Categorical variables were analyzed with Fisher's exact test. Continuous variables were analyzed with Mann-Whitney U test. Significance was defined at P < .05. RESULTS Of the 432 patients identified, 342 met inclusion criteria. Median (interquartile range) ages for the abducted and tucked cohorts were 40 (31) and 34 (28) years, respectively (P < .01). Males comprised 55.4% (n = 41) and 54.1% (n = 145) of abducted and tucked groups, respectively (P = .9). PUN frequency was 6.8% (n = 5) for abducted subjects and 3.7% (n = 10) for tucked subjects (relative risk 1.8, 95% confidence interval [0.7, 5.1]; P = .33). PUN was associated with gender (P = .01), American Society of Anesthesiologists status (P = .03), BMI (P = .01), and GA duration (P < .01) on bivariate analysis. When adjusting for covariates, only GA duration (P < .01) and BMI (P = .03) were associated with PUN development. CONCLUSION AND RELEVANCE The findings suggest that PUN development during OMS procedures was not associated with UE position.
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Affiliation(s)
- Allen F Champion
- Associate Professor, Department of Oral and Maxillofacial Surgery, Thomas Jefferson University, Philadelphia, PA.
| | - Anthony D Congiusta
- Former Resident, Department of Oral and Maxillofacial Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Alyssa F Manski
- Former Resident, Department of Oral and Maxillofacial Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Jung-Me Lee
- Bachelor of Science Candidate, Cornell University, Ithaca, NY
| | - Aviana Duca
- Resident, Department of Oral and Maxillofacial Surgery, Thomas Jefferson University, Philadelphia, PA
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Cannoletta D, Pellegrino AA, Pettenuzzo G, Morgantini L, Calvo RS, Torres-Anguiano JR, Mazzone E, Antonelli A, Montorsi F, Briganti A, Crivellaro S. Surgical outcomes of novel retroperitoneal low anterior vs posterior and transperitoneal access in single-port partial nephrectomy. World J Urol 2024; 42:387. [PMID: 38958744 DOI: 10.1007/s00345-024-05096-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 05/29/2024] [Indexed: 07/04/2024] Open
Abstract
PURPOSE Single-Port Robot-Assisted Partial Nephrectomy (SP-RAPN) can be performed by transperitoneal and retroperitoneal approaches. However, there is a lack of surgical outcomes for novel Retroperitoneal Low Anterior Access (LAA) in SP-RAPN. The study compared outcomes of the standard approach (SA), considering transperitoneal (TP) and posterior retroperitoneal (RP) access vs LAA in SP-RAPN series. METHODS 102 consecutive patients underwent SP-RAPN between 2019 and 2023 at a tertiary referral robotic center were identified. Baseline characteristics, peri- and post-operative outcomes were collected. Patients were stratified according to surgical approach into standard (RP or TP) vs LAA and, subsequently, RP vs LAA. Multivariable logistic regression analysis was used to test the probability of the same-day discharge adjusting for comorbidity indexes. RESULTS Overall, 102 consecutive patients were included in this study (68 SA - 26 TP and 42 posterior RP vs 34 LAA). Median age was 60 (IQR 51.5-66) years and median BMI was 31 (IQR 26.3-37.6). No baseline differences were observed. LAA exhibited significantly shorter length of stay (LOS) (median 10 [IQR 8-12] vs 24 [IQR 12-30.2.] hours, p < .0001), reduced post-operative pain (p < .0001) and decreased narcotic use on 0-1 PO Day (p < .001) compared to SA and RP only. Multivariate analysis, adjusting for comorbidities, identified LAA as a strong predictor for Same-Day Discharge. CONCLUSION LAA is an effective approach as well as RP and TP, regardless of the renal mass location, whether it is anterior or posterior, upper/mid or lower pole, yielding favorable outcomes in LOS, post-operative pain and decreased narcotics use compared to SA in SP-RAPN.
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Affiliation(s)
- Donato Cannoletta
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA.
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Antony Angelo Pellegrino
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Greta Pettenuzzo
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Luca Morgantini
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Ruben Sauer Calvo
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Elio Mazzone
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
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Cannoletta D, Pettenuzzo G, Pellegrino AA, Morgantini L, Calvo Sauer R, Torres Anguiano JR, Mazzone E, Antonelli A, Montorsi F, Briganti A, Crivellaro S. Versatility of Single Port Retroperitoneal Low Anterior Access: Early Outcomes in Multiple Procedures. J Endourol 2024; 38:668-674. [PMID: 38613809 DOI: 10.1089/end.2024.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2024] Open
Abstract
Purpose: This study aimed to assess early outcomes of the single port (SP) robotic low anterior access (LAA) for all upper urinary tract surgeries. In addition, it aimed to explore the impact of clinical factors, notably Body Mass Index (BMI), on post-operative outcomes and length of hospital stay. Materials and Methods: Overall, 76 consecutive patients underwent SP robotic surgery with LAA involving all upper urinary tract pathologies, with data collected prospectively. Baseline characteristics, intra- and post-operative outcomes, pain levels, and opioid use were analyzed. Statistical methods, including logistic regression and locally weighted scatterplot smoothing analysis, were used to assess same-day discharge (SDD) predictors and the association between BMI and SDD probability. According to the Institutional Review Board (IRB) protocol, only data recorded in our electronic medical record system was included. Results: Ten different procedures were performed with LAA, with no need for conversion to open surgery and complication rates in line with the literature (30 days: 5%, 90 days: 6.6%). Notably, 77.6% of patients were discharged on the same day. A significant association was found between BMI and prolonged hospital stay, particularly in obese patients (BMI ≥30 kg/m2). Post-operative pain was generally low (median VAS: 4), with over 70% discharged without opioid prescriptions. Conclusions: The novel LAA is a versatile approach for various upper urinary tract surgeries, including in obese patients. While achieving satisfactory post-operative outcomes, increased BMI correlated with a reduced likelihood of SDD. Further studies, including larger cohorts and multicenter collaborations, are warranted to explore anesthesiologic management and validate these findings.
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Affiliation(s)
- Donato Cannoletta
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Greta Pettenuzzo
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Antony Angelo Pellegrino
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Luca Morgantini
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ruben Calvo Sauer
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | | | - Elio Mazzone
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
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Razdan S, Okhawere KE, Zuluaga L, Saini I, Ucpinar B, Sauer RC, Soputro N, Crivellaro S, Kaouk JH, Ahmed M, Stifelman MD, Badani KK. Comparison of lateral flank approach and low anterior access for single port (SP) retroperitoneal partial nephrectomy: an analysis from the single port advanced research consortium (SPARC). J Robot Surg 2024; 18:216. [PMID: 38761306 DOI: 10.1007/s11701-024-01969-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 05/03/2024] [Indexed: 05/20/2024]
Abstract
Single Port (SP) robotic partial nephrectomy (RPN) can be performed via retroperitoneal and transperitoneal approach. We aim to compare outcomes of two commonly described incisions for retroperitoneal SP RPN: lateral flank approach (LFA) and low anterior access (LAA). We performed a retrospective study of patients who underwent SP retroperitoneal RPN from 2018 to 2023 as part of a large multi-institute collaboration (SPARC). Baseline demographic, clinical, tumor-specific characteristics, and perioperative outcomes were compared using χ2, t test, Fisher exact test, and Mann-Whitney U test. Multivariable analyses were conducted using robust and logistic regressions. A total of 70 patients underwent SP retroperitoneal RPN, with 44 undergoing LAA. Overall, there were no significant differences in baseline characteristics between the two groups. The LAA group exhibited significantly lower median RENAL scores (8 vs. 5, p < 0.001) and more varied tumor locations (p = 0.002). In the bivariate analysis, there were no statistically significant differences in ischemia time, estimated blood loss, or complication rates between the groups. However, the LAA group had longer operative times (101 vs. 134 min, p < 0.001), but was more likely to undergo a same-day discharge (p < 0.001). When controlling for other variables, LAA was associated with shorter ischemia time (p = 0.005), but there was no significant difference in operative time (p = 0.348) and length of stay (p = 0.122). Both LFA and LAA are acceptable approaches for SP retroperitoneal RPN with comparable perioperative outcomes. This early data suggests the LAA is more versatile for varying tumor locations; however, larger cohort studies are needed to ascertain whether there is an overall difference in patient recovery.
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Affiliation(s)
- Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA.
| | - Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
| | - Laura Zuluaga
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
| | - Indu Saini
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
| | - Burak Ucpinar
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
| | | | - Nicholas Soputro
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - J H Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mutahar Ahmed
- Hackensack University Medical Center, Hackensack, NJ, USA
| | | | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
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Bentsen SB, Eide GE, Wiig S, Rustøen T, Heen C, Bjøro B. Patient positioning on the operating table and patient safety: A systematic review and meta-analysis. J Adv Nurs 2024. [PMID: 38186052 DOI: 10.1111/jan.16049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/01/2023] [Accepted: 12/17/2023] [Indexed: 01/09/2024]
Abstract
AIM To identify occurrence of harmful incidents related to patient positioning on operating table. DESIGN Systematic review and meta-analysis. DATA SOURCES Eight databases including Ovid, Medline, Embase, CINAHL, the Cochrane Library, Epistemonikos, Scopus, Web of Science and Google Scholar were systematically searched from the inception of the databases to August 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram depicting the flow information. REVIEW METHODS The Cochrane Risk of Bias Tools were used to assess the risk of bias. Risk of harm with 95% confidence interval (CI) was estimated for each included study, and an overall risk was calculated using meta-analysis. RESULTS Of the 22 included reports, two were randomized controlled trials (RCTs), five had a prospective cohort design, three had a cross-sectional design, and 12 were register-based studies. Intraoperative peripheral nerve injuries, perioperative pressure ulcers, musculoskeletal injuries, vascular injuries, postoperative pain and eye injuries were related to supine, lithotomy, Trendelenburg, prone and beach chair positioning. Overall risk of any harm was estimated as 0.2%. Studies with patients placed in prone positioning (8 study samples) had the highest risks of harm varying from 0.19 to 0.81, with an overall risk of 0.33. Meta-analysis of the two RCTs showed higher risk of chemosis with head-down positioning than with head in neutral position (overall relative risk = 1.64; 95% CI: [1.25, 2.14]). CONCLUSIONS Harmful incidents related to patient positioning occur and consequences can be severe. The operating room teams should be aware of the harms and prevent and treat them seriously. IMPACT This review underlines that research is sparse on patient positioning on operating table and harmful incidents. There is a need for high-quality, well-designed studies that focus on harmful incidents and prevention of harm related to patient positioning. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution, as this is a review of previous research.
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Affiliation(s)
- Signe Berit Bentsen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Division of Emergencies and Critical Care, Department of Operating Services, Oslo University Hospital, Oslo, Norway
| | - Geir Egil Eide
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Siri Wiig
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- SHARE Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Tone Rustøen
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
- Department of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Cathrine Heen
- Division of Emergencies and Critical Care, Department of Operating Services, Oslo University Hospital, Oslo, Norway
| | - Benedikte Bjøro
- Department of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Department of Operating Services, Oslo University Hospital, Oslo, Norway
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10
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Żelechowski M, Faludi B, Karnam M, Gerig N, Rauter G, Cattin PC. Automatic patient positioning based on robot rotational workspace for extended reality. Int J Comput Assist Radiol Surg 2023; 18:1951-1959. [PMID: 37296352 PMCID: PMC10589133 DOI: 10.1007/s11548-023-02967-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Understanding the properties and aspects of the robotic system is essential to a successful medical intervention, as different capabilities and limits characterize each. Robot positioning is a crucial step in the surgical setup that ensures proper reachability to the desired port locations and facilitates docking procedures. This very demanding task requires much experience to master, especially with multiple trocars, increasing the barrier of entry for surgeons in training. METHODS Previously, we demonstrated an Augmented Reality-based system to visualize the rotational workspace of the robotic system and proved it helps the surgical staff to optimize patient positioning for single-port interventions. In this work, we implemented a new algorithm to allow for an automatic, real-time robotic arm positioning for multiple ports. RESULTS Our system, based on the rotational workspace data of the robotic arm and the set of trocar locations, can calculate the optimal position of the robotic arm in milliseconds for the positional and in seconds for the rotational workspace in virtual and augmented reality setups. CONCLUSIONS Following the previous work, we extended our system to support multiple ports to cover a broader range of surgical procedures and introduced the automatic positioning component. Our solution can decrease the surgical setup time and eliminate the need to repositioning the robot mid-procedure and is suitable both for the preoperative planning step using VR and in the operating room-running on an AR headset.
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Affiliation(s)
- Marek Żelechowski
- Center for medical Image Analysis & Navigation (CIAN), Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
| | - Balázs Faludi
- Center for medical Image Analysis & Navigation (CIAN), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Murali Karnam
- Bio-Inspired RObots for MEDicine-Laboratory (BIROMED-lab), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Nicolas Gerig
- Bio-Inspired RObots for MEDicine-Laboratory (BIROMED-lab), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Georg Rauter
- Bio-Inspired RObots for MEDicine-Laboratory (BIROMED-lab), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Philippe C Cattin
- Center for medical Image Analysis & Navigation (CIAN), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
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11
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Togioka BM, Harriman KA, Ye S, Berli J. Frequency and Characteristics of Postoperative Neuropathy in Individuals on Gender-Affirming Hormone Therapy Undergoing Gender Affirmation Surgery: A Retrospective Cohort Study. Cureus 2023; 15:e47988. [PMID: 38034215 PMCID: PMC10686520 DOI: 10.7759/cureus.47988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Gender affirmation surgery includes procedures of the face, larynx, chest, reproductive system, external genitalia, and adipose tissue performed to ameliorate incongruence between gender identity and phenotype. The annual number of gender affirmation surgeries performed in the United States has increased significantly. There have been no investigations into the frequency of peripheral neuropathy after gender affirmation surgery, which is an important topic, given transgender individuals are at increased risk for delaying necessary medical care. After appreciating a number of cases of postoperative neuropathy in our clinical practice, we hypothesized that gender affirmation surgery is a high-risk procedure for postoperative neuropathy. Methods We conducted a one-year, monocentric, retrospective cohort study utilizing clinical data of individuals on gender-affirming hormone therapy undergoing gender-affirmation surgery under general anesthesia. The study included transgender women, assigned male at birth, receiving antiandrogen, progesterone, or estrogen therapy (target range plasma estradiol concentration 90-200 pg/ml) and transgender men, assigned female at birth, receiving antiestrogen or testosterone therapy (target range plasma testosterone concentration 320-1000 ng/dl). The primary objective was to estimate the incidence of postoperative peripheral neuropathy, defined as new numbness, paresthesia, neuropathic pain, or muscle weakness occurring in a peripheral innervation territory. Secondary objectives were to summarize the clinical presentation of neuropathy and investigate for associations between procedure characteristics and neuropathy. Results We identified nine cases of postoperative peripheral nerve injury in 232 consecutive gender affirmation procedures establishing an incidence of 3.9%. All injuries were associated with surgery longer than six hours and were characterized by sensory deficits including numbness 89% (8/9) and tingling 56% (5/9), which were diagnosed by postoperative day one. Conclusions Our results suggest that gender affirmation surgery is a high-risk procedure for postoperative neuropathy, with an incidence similar to other high-risk procedures, and an incidence that is higher than the general surgical population. However, given this has not been previously reported and our study includes a heterogenous population from a single institution, our results should be considered hypothesis generating. Additional studies that include multiple institutions are needed to confirm our findings and identify modifiable risk factors for postoperative neuropathy.
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Affiliation(s)
- Brandon M Togioka
- Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, USA
| | | | - Shangyuan Ye
- Biostatistics, Oregon Health & Science University, Portland, USA
| | - Jens Berli
- Plastic Surgery, Oregon Health & Science University, Portland, USA
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12
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Pellegrino AA, Chen G, Morgantini L, Calvo RS, Crivellaro S. Simplifying Retroperitoneal Robotic Single-port Surgery: Novel Supine Anterior Retroperitoneal Access. Eur Urol 2023; 84:223-228. [PMID: 37211448 DOI: 10.1016/j.eururo.2023.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/05/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Multiport robotic surgery in the retroperitoneum is limited by the bulky robotic frame and clashing of instruments. Moreover, patients are placed in the lateral decubitus position, which has been linked to complications. OBJECTIVE To assess the feasibility and safety of a supine anterior retroperitoneal access (SARA) technique with the da Vinci Single-Port (SP) robotic platform. DESIGN, SETTING, AND PARTICIPANTS Between October 2022 and January 2023, 18 patients underwent surgery using the SARA technique for renal cancer, urothelial cancer, or ureteral stenosis. Perioperative variables were prospectively collected and outcomes were assessed. SURGICAL PROCEDURE With the patient in a supine position, a 3-cm incision is made at the McBurney point and the abdominal muscles are dissected. Finger dissection is used to develop the retroperitoneal space for the da Vinci SP access port. After docking, the first step is to dissect retroperitoneal tissue to reveal the psoas muscle. This allows identification of the ureter, the inferior renal pole, and the hilum. MEASUREMENTS A descriptive statistical analysis was performed. Data collected included demographics, operative time, warm ischemia time (WIT), surgical margin status, complications, length of hospital stay, 30-d Clavien-Dindo complications, and postoperative narcotic use. RESULTS AND LIMITATIONS Twelve patients underwent partial nephrectomy (PN) and two each underwent pyeloplasty, radical nephroureterectomy, and radical nephrectomy. In the PN group, mean age was 57 yr (interquartile range [IQR] 30-73), median body mass index was 32 kg/m2 (IQR 17-58), and 25% had stage ≥3 chronic kidney disease. The median Charlson comorbidity index was 3 (IQR 0-7) and 75% of PN patients had an American Society of Anesthesiologists score ≥3. The median RENAL score was 5 (IQR 4-7). The median WIT was 25 min (IQR 16-48) and the median tumor size was 35 mm (IQR 16-50). The median estimated blood loss was 105 ml (IQR 20-400) and the median operative time was 160 min (IQR 110-200). Positive surgical margins were found in one patient. In the overall cohort, one patient was readmitted and managed conservatively; 83% of the PN group were discharged on the same day as their surgery, with the remainder discharged the next day. At 7 d after surgery, no patients reported narcotic use. CONCLUSIONS The SARA approach is feasible and safe. Larger studies are needed to confirm this approach as a one-step solution for upper urinary tract surgery. PATIENT SUMMARY We assessed initial outcomes of a novel approach for accessing the retroperitoneum (the space behind the abdominal cavity and in front of the back muscles and spine) during robot-assisted surgery in the upper urinary tract. The patient is placed on their back and surgery is performed with a single-port robot. Our results show that this approach was feasible and safe, with low complication rates, less postoperative pain, and earlier discharge. This is a promising start, but larger studies are needed to confirm our findings.
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Affiliation(s)
- Antony A Pellegrino
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Department of Urology, University of Illinois at Chicago, Chicago, IL, USA.
| | - Grace Chen
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Luca Morgantini
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Ruben Sauer Calvo
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
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13
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Preventing patient positioning injuries in the nonoperating room setting. Curr Opin Anaesthesiol 2022; 35:465-471. [PMID: 35861473 DOI: 10.1097/aco.0000000000001153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Postprocedural positioning injuries are an under-appreciated source of morbidity for patients. These injuries may not present until days after anesthesia and may be missed for multiple reasons including the distracting injury of the procedural site, illness of the patient, lack of follow-up, and insufficient awareness of this type of injury. Risks for these adverse events are exacerbated in the nonoperating room anesthesia (NORA) population for several reasons. These patients tend to be older and sicker than patients presenting to the operating room, increasing the risk of an injury. Proceduralists and anesthesia providers are usually consultants, not the primary care team, so may have limited patient follow-up. This review will discuss the risk factors for position-related injuries and how to prevent them with proper positioning and padding. RECENT FINDINGS The mainstay of preventing periprocedural positioning injuries is careful positioning of the patient and proper padding of pressure points. This may be particularly challenging because of physical constraints and positioning requirements for NORA procedures, as well as preference for radiolucent positioning materials. Recent studies have shown the potential benefit of monitoring somatosensory evoked potentials (SSEP) in high-risk patients. SUMMARY Careful consideration of patient positioning and thorough understanding of peripheral nerve and pressure injuries is essential for anesthesia providers to avoid positioning injuries during NORA procedures. VIDEO ABSTRACT http://links.lww.com/COAN/A87.
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Kimura N, Yamada Y, Takeshima Y, Otsuka M, Akamatsu N, Hakozaki Y, Miyakawa J, Sato Y, Akiyama Y, Yamada D, Fujimura T, Kume H. The 'prostate-muscle index': a simple pelvic cavity measurement predicting estimated blood loss and console time in robot-assisted radical prostatectomy. Sci Rep 2022; 12:11945. [PMID: 35831361 PMCID: PMC9279306 DOI: 10.1038/s41598-022-16202-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
This study was to show the impact of ‘prostate-muscle index (PMI)’, which we developed as a novel pelvic cavity measurement, in patients undergoing robot-assisted radical prostatectomy (RARP). We defined PMI as the ‘distance between the inner edge of the obturator internus muscle and the lateral edge of the prostate at the magnetic resonance imaging (MRI) slice showing the maximum width of the prostate’. Seven hundred sixty patients underwent RARP at the University of Tokyo Hospital from November 2011 to December 2018. MRI results were unavailable in 111 patients. In total, 649 patients were eligible for this study. Median values of blood loss and console time were 300 mL and 168 min. In multivariate analysis, body mass index (BMI), prostate volume-to-pelvic cavity index (PV-to-PCI), PMI, and surgical experience were significantly associated with blood loss > 300 mL (P = 0.0002, 0.002, < 0.0001, and 0.006 respectively). Additionally, BMI, PMI, and surgical experience were also significantly associated with console time > 160 min in multivariate analysis (P = 0.04, 0.004, and < 0.0001, respectively). In conclusion, PMI may provide useful information to surgeons and patients in preoperative decision-making.
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Affiliation(s)
- Naoki Kimura
- Department of Urology, National Center for Global Health and Medicine, Shinjuku-Ku, Tokyo, Japan.,Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
| | - Yuta Takeshima
- Division of Innovative Cancer Therapy, The Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Minato-Ku, Tokyo, Japan
| | | | - Nobuhiko Akamatsu
- Department of Radiology, Nerima Hikarigaoka Hospital, Nerima-Ku, Tokyo, Japan
| | - Yuji Hakozaki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Jimpei Miyakawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yusuke Sato
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yoshiyuki Akiyama
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Daisuke Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Tetsuya Fujimura
- Department of Urology, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
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Khan MA, Burden J, Dinsmore J, Lockwood AJ. Making cataract surgery possible in patients with ankylosing spondylitis: A new positioning technique. Am J Ophthalmol Case Rep 2022; 25:101246. [PMID: 35005297 PMCID: PMC8717412 DOI: 10.1016/j.ajoc.2021.101246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/25/2021] [Accepted: 12/19/2021] [Indexed: 11/15/2022] Open
Abstract
Importance Patients with Ankylosing Spondylitis frequently have fixed kyphosis of their spine together with pain. This makes achieving acceptable head position for ocular surgery difficult. The proposal of new methods that result in successful intraocular surgery will reduce morbidity and sight loss in this group of patients. Objective To describe a novel technique using a vacuum bean bag positioner which enabled cataract surgery to be performed successfully under local anaesthesia. To allow prospects of technique development to standardise cataract surgery positioning in this cohort. Results A 42 year-old male patient underwent phacoemulsification under Sub-Tenon's local anaesthetic with intra-ocular lens implant in the inverted position with no immediate post-operative complications. Conclusions and Relevance Standard operating theatre equipment combined with a vacuum bean bag positioner, soft supports and securing straps can attain a position that is feasible for awake ocular surgery in patients with gross anatomical changes affecting the neck. Describe a novel technique for phacoemulsification and intra-ocular lens implant. Enabling awake cataract surgery in patients with fixed kyphosis. Successfully undertake surgery in the inverted position due to fixed flexion deformity.
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Affiliation(s)
- Muneeb Ahmad Khan
- Portsmouth Hospitals University NHS Trust, Cosham, Portsmouth, PO63LY, United Kingdom
| | - John Burden
- Portsmouth Hospitals University NHS Trust, Cosham, Portsmouth, PO63LY, United Kingdom
| | - James Dinsmore
- Portsmouth Hospitals University NHS Trust, Cosham, Portsmouth, PO63LY, United Kingdom
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Żelechowski M, Karnam M, Faludi B, Gerig N, Rauter G, Cattin PC. Patient positioning by visualising surgical robot rotational workspace in augmented reality. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2021. [DOI: 10.1080/21681163.2021.2002192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Marek Żelechowski
- Center for Medical Image Analysis & Navigation (CIAN), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Murali Karnam
- Bio-Inspired RObots for MEDicine-Laboratory (BIROMED-lab), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Balázs Faludi
- Center for Medical Image Analysis & Navigation (CIAN), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Nicolas Gerig
- Bio-Inspired RObots for MEDicine-Laboratory (BIROMED-lab), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Georg Rauter
- Bio-Inspired RObots for MEDicine-Laboratory (BIROMED-lab), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Philippe C. Cattin
- Center for Medical Image Analysis & Navigation (CIAN), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
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17
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Cornelius J, Mudlagk J, Afferi L, Baumeister P, Mattei A, Moschini M, Iselin C, Mordasini L. Postoperative peripheral neuropathies associated with patient positioning during robot-assisted laparoscopic radical prostatectomy (RARP): A systematic review of the literature. Prostate 2021; 81:361-367. [PMID: 33764601 DOI: 10.1002/pros.24121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/28/2021] [Accepted: 03/10/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To perform a systematic review of the literature concerning postoperative peripheral neuropathies associated with patient positioning during robot-assisted laparoscopic radical prostatectomy (RARP). PATIENTS AND METHODS A systematic review on articles published from January 1, 1990 to March 15, 2020 was performed in accordance with the PRISMA declaration (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). The electronic search was done searching through the Cochrane Registry, PubMed/EMBASE, Medline, and Scopus. Relevant papers addressing postoperative peripheral neuropathies related to patient positioning during RARP were integrated into the analyses. RESULTS After screening 4975 articles, one randomized controlled trial and five retrospective studies with a total of 63,667 patients were included in this review. Peripheral neuropathies of the upper extremities were documented in three articles with a total of 15 patients, peripheric neuropathies of the lower extremities were reported in five articles with a total of 76 patients. Analysis of the data was exploratory, since screening techniques, systematically reporting, and description of positioning techniques was not standardized or not reported. CONCLUSIONS The incidence of peripheral neuropathies at RARP varies between 1.3% and 10.8%. Lower extremities are more affected than upper extremities and the most important risk factors are intraoperative time duration, patients comorbidities, and ASA score. High-quality prospective randomized studies to better assess the impact of patient positioning during RARP on the development postoperative peripheral neuropathies are needed.
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Affiliation(s)
- Julian Cornelius
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jonas Mudlagk
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
- University Witten/Herdecke, Witten, Germany
| | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
- Université de Genèva, Genèva, Switzerland
| | - Marco Moschini
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Christophe Iselin
- Université de Genèva, Genèva, Switzerland
- Department of Urology, University Hospital Geneva, Geneva, Switzerland
| | - Livio Mordasini
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
- Université de Genèva, Genèva, Switzerland
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18
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Laso-García IM, Arias-Fúnez F, Duque-Ruiz G, Díaz-Pérez D, Lorca-Álvaro J, Burgos-Revilla FJ. Well-Leg Compartment Syndrome After Percutaneous Nephrolithotomy in the Galdakao-Modified Supine Valdivia Position. Res Rep Urol 2020; 12:295-302. [PMID: 32802806 PMCID: PMC7386809 DOI: 10.2147/rru.s259357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/18/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose The objective is to present a case of well-leg compartment syndrome in the Galdakao-modified supine Valdivia position. Results The case of a 32-year-old male, obese (105 Kg) and a former smoker is presented. The patient was positioned in the Galdakao-modified supine Valdivia position, with lower limbs bandaged, to perform a right percutaneous nephrolithotomy. In the immediate postoperative period, significant pain was reported in the left lower limb. The limb appeared oedematous and cyanotic, although pedis pulses were preserved. Doppler ultrasound ruled out venous thrombosis. Suspecting compartment syndrome, the patient underwent a complete decompression fasciotomy of the four left leg compartments. After the surgery, values of creatine phosphokinase reached 80.000 UI/L and serum creatinine levels were 1.53 mg/dL. The patient was taken to the intensive care unit. Six months after the episode, the patient still needs rehabilitation care. The compartment syndrome is a rare complication in lithotomy position, but never described in the Galdakao-modified supine Valdivia position before, with the lower limbs in moderate flexion, and with the ipsilateral lower limb in a slightly inferior position with respect to the other. It may lead to skin necrosis, permanent neuromuscular dysfunction, myoglobinuric renal failure, amputation and even death. Therefore, this complication must be suspected and early decompression of the compartment must be performed. Risk factors include obesity, peripheral vascular disease (advanced age, hypertension, hyperlipidemia and diabetes mellitus), height, hypothermia, acidemia, BMI, male sex, combined general-spinal anesthesia, prolonged surgery time, systemic hypotension, ASA (American Society of Anesthesiologists) class, lack of operative experience, vasoconstricting drugs, important bleeding during the surgery and increased muscle bulk. Conclusion Compartment syndrome is a potentially life-threatening complication that may occur in the Galdakao-modified supine Valdivia position. It should be suspected in cases with risk factors and compatible clinical symptoms and signs, and treated rapidly to avoid further complications.
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Affiliation(s)
- Inés María Laso-García
- Urology Department, Ramón y Cajal University Hospital, Alcalá University, IRYCIS, Madrid, Spain
| | - Fernando Arias-Fúnez
- Urology Department, Ramón y Cajal University Hospital, Alcalá University, IRYCIS, Madrid, Spain
| | - Gema Duque-Ruiz
- Urology Department, Ramón y Cajal University Hospital, Alcalá University, IRYCIS, Madrid, Spain
| | - David Díaz-Pérez
- Urology Department, Ramón y Cajal University Hospital, Alcalá University, IRYCIS, Madrid, Spain
| | - Javier Lorca-Álvaro
- Urology Department, Ramón y Cajal University Hospital, Alcalá University, IRYCIS, Madrid, Spain
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Haig F, Medeiros ACB, Chitty K, Slack M. Usability assessment of Versius, a new robot-assisted surgical device for use in minimal access surgery. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2020; 2:e000028. [PMID: 35047788 PMCID: PMC8749256 DOI: 10.1136/bmjsit-2019-000028] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/24/2020] [Accepted: 04/09/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Versius is a teleoperated surgical robotic system intended for use in minimal access surgery. This study aimed to validate the safety and effectiveness of the Versius user interface in the hands of trained users and identify and address the causes of any user errors. DESIGN Surgical teams completed a commercially representative training program over 3.5 days. After training was completed, the usability-related aspects of the system were assessed. SETTING A simulated operating room using a cadaveric model. PARTICIPANTS Surgical teams consisting of a lead surgeon, assistant surgeon, scrub nurse and circulating nurse. MAIN OUTCOME MEASURES Usability-related aspects of the system were assessed through the completion of critical and non-critical tasks. A critical task was defined according to the Food and Drug Administration's definition, as a user task which, if performed incorrectly or not performed at all, would or could cause serious harm to the patient or user, where harm is defined to include compromised medical care. RESULTS In total, 17 surgical teams participated in the study and all were experienced in laparoscopic surgery. The number of robotic surgeries performed by the participants per month ranged from 0 to 100. Surgical specialties were similarly represented from obstetrics and gynecology, colorectal, urology and upper gastrointestinal. No critical task failures were observed. Of all the tasks completed, 98% were recorded as a pass or a pass with difficulty. CONCLUSIONS These results demonstrate that in a simulated clinical setting, Versius can be safely used by both laparoscopically and robotically trained healthcare professionals. These results support the progression to assessment of Versius in preclinical studies.
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Affiliation(s)
- Fiona Haig
- CMR Surgical, Cambridge, Cambridgeshire, UK
| | | | | | - Mark Slack
- CMR Surgical, Cambridge, Cambridgeshire, UK
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Halpern DK, Liu HH, Howell RS, Halpern RM, Akerman M, Conlon J, Weidler C. Neural Monitoring for Robotic Abdominal Wall Reconstruction. JSLS 2020; 24:JSLS.2020.00009. [PMID: 32327919 PMCID: PMC7173774 DOI: 10.4293/jsls.2020.00009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction: Positioning-related neural injuries are an inherent risk in surgery, particularly in robotic-assisted abdominal wall reconstruction because of unique patient positioning and increased operative times. The implementation of intraoperative neurophysiological monitoring should be considered in such cases. Methods: This was a two-armed study with one prospective intervention group and one retrospective control group. All patients underwent robotic abdominal wall reconstruction at an academic center. The prospective arm underwent robotic reconstruction from January through July 2019. The retrospective database reviewed patients who underwent the same procedure from August 2015 through July 2018. Factors assessed included: demographics (age, gender, body mass index, comorbidities), surgical details (American Society of Anesthesiologists class, procedure, operative time, positioning), outcomes (length of stay, 30-d readmission, reoperation), and any new-onset intraoperative or postoperative neuropathy. Patients were seen in the clinic postoperatively at weeks 1 and 6. Results: Ten patients were included in the prospective arm. All received intraoperative neurophysiological monitoring using somatosensory evoked potentials. They were compared with 47 patients in the retrospective arm who underwent surgery without intraoperative neurophysiological monitoring. One position-related neural response from baseline was detected intraoperatively in the prospective arm; however, there were no peripheral neurological symptoms present postoperatively. Two patients in the control group developed transient peripheral neuropathies that resolved within 6 weeks. Demographics, surgical procedures, and length of surgery were similar in both groups. The prospective group had a higher rate of preoperative neuropathy and intraoperative use of vasopressors. Conclusion: Incorporation of neurophysiological monitoring in robotic surgery is feasible and may lead to the prevention and reduction in positioning-related injuries.
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Affiliation(s)
- David K Halpern
- Department of Surgery, New York University Winthrop Hospital, Mineola, New York
| | - Helen H Liu
- Department of Surgery, New York University Winthrop Hospital, Mineola, New York
| | - Raelina S Howell
- Department of Surgery, New York University Winthrop Hospital, Mineola, New York
| | - Robert M Halpern
- Department of Surgery, New York University Winthrop Hospital, Mineola, New York
| | - Meredith Akerman
- Department of Biostatistics, New York University Winthrop Hospital, Mineola, New York
| | - Joseph Conlon
- Physiologic Assessment Services, Teaneck, New Jersey
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Watson MJ, Koch B, Tonzi M, Xu R, Heath G, Lute B, Singh A. Decreasing the prospect of upper extremity neuropraxia during robotic assisted laparoscopic prostatectomy: a novel technique. J Robot Surg 2020; 14:733-738. [PMID: 31997148 DOI: 10.1007/s11701-020-01047-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/20/2020] [Indexed: 10/25/2022]
Abstract
Risk of intraoperative neuropathic injury in minimally invasive surgery has been established as a leading complication. Continuous intraoperative neuromonitoring (IONM), such as upper extremity somatosensory evoked potentials (ueSSEPs), to decrease peripheral nerve injury due to positional stress has been described. Robotic-assisted laparoscopic prostatectomy (RALP) requires steep Trendelenberg, which may predispose patients to upper extremity neuropraxia. Subdermal stimulating electrodes were placed on the patients' bilateral wrists over the ulnar nerve and the nerve was stimulated. Realtime waveforms were compared to baseline data to prevent and detect injury to the ulnar nerve. Established intervention criteria, indicating risk for neuropathic damage necessitating intraoperative patient repositioning, was a 50% loss in amplitude or a 10% increase in latency. One hundred and forty three patients received RALP with IONM. 17 of 143 patients (11.8%) met ueSSEP intervention criteria. Only weight was significantly different between the two groups (p = 0.04). Mean reduction in amplitude was 79.9% (SE 4.1). Average amplitude loss duration was 22 min (SE 4.0). Weight and BMI were correlated to the degree of amplitude reduction (p = 0.03 and < 0.01), while operative time and DM approached significance (p = 0.09 and p = 0.14). This is the first study to use IONM to reduce the risk of nerve injury during genitourinary surgery. Realtime nerve monitoring using ueSSEP allowed for upper extremity intraoperative monitoring and repositioning. This may decrease the risk of upper extremity neuropraxia due to malpositioning during RALP. Weight and BMI were identified as risk factors for possible nerve injury. Further data collection and analysis to preoperatively stratify patients for application of IONM during RALP is currently ongoing.
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Affiliation(s)
- Matthew J Watson
- Department of Urology, University of Tennessee Erlanger, 979 East Third Street, Suite C-925, Chattanooga, TN, 37403, USA
| | | | - Michael Tonzi
- Department of Urology, University of Tennessee Erlanger, 979 East Third Street, Suite C-925, Chattanooga, TN, 37403, USA
| | - Raymond Xu
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Gregory Heath
- Department of Human Performance, University of Tennessee-Chattanooga, Chattanooga, TN, USA
| | | | - Amar Singh
- Department of Urology, University of Tennessee Erlanger, 979 East Third Street, Suite C-925, Chattanooga, TN, 37403, USA.
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22
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Electrically-Evoked Proximity Sensation Can Enhance Fine Finger Control in Telerobotic Pinch. Sci Rep 2020; 10:163. [PMID: 31932709 PMCID: PMC6957695 DOI: 10.1038/s41598-019-56985-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/19/2019] [Indexed: 11/24/2022] Open
Abstract
For teleoperation tasks requiring high control accuracy, it is essential to provide teleoperators with information on the interaction between the end effector and the remote environment. Real-time imaging devices have been widely adopted, but it delivers limited information, especially when the end effectors approach the target following the line-of-sight. In such situations, teleoperators rely on the perspective at the screen and can apply high force unintentionally at the initial contact. This research proposes to deliver the distance information at teleoperation to the fingertips of teleoperators, i.e., proximity sensation. Transcutaneous electrical stimulation was applied onto the fingertips of teleoperators, with the pulsing frequency inversely proportional to the distance. The efficacy of the proximity sensation was evaluated by the initial contact force during telerobotic pinch in three sensory conditions: vision only, vision + visual assistance (distance on the screen), and vision + proximity sensation. The experiments were repeated at two viewing angles: 30–60° and line-of-sight, for eleven healthy human subjects. For both cases, the initial contact force could be significantly reduced by either visual assistance (20–30%) or the proximity sensation (60–70%), without additional processing time. The proximity sensation is two-to-three times more effective than visual assistance regarding the amount of force reduction.
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23
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Bjøro B, Mykkeltveit I, Rustøen T, Candas Altinbas B, Røise O, Bentsen SB. Intraoperative peripheral nerve injury related to lithotomy positioning with steep Trendelenburg in patients undergoing robotic-assisted laparoscopic surgery - A systematic review. J Adv Nurs 2019; 76:490-503. [PMID: 31736124 DOI: 10.1111/jan.14271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/08/2019] [Accepted: 11/05/2019] [Indexed: 12/22/2022]
Abstract
AIMS To examine the incidence of intraoperative peripheral nerve injury, symptoms, risk factors, functions, and quality of life in patients undergoing robotic-assisted laparoscopic surgery to lithotomy positioning with steep Trendelenburg. DESIGN A systematic review. DATA SOURCES The Cochrane Library catalogue, PubMed, EMBASE, CINHAL and SveMed + databases were searched from January 2000 - February 2019. REVIEW METHODS Titles and abstracts were screened for inclusion. Full-text assessments of each paper were conducted by two reviewers. The quality of the included papers was assessed using the Mixed Methods Appraisal Tool. Descriptive statistics and thematic analysis were used to synthesize the data. RESULTS Eleven quantitative studies were included with three themes: (a) incidence of intraoperative peripheral nerve injury; (b) upper extremity intraoperative peripheral nerve injury related to steep Trendelenburg positioning; and (c) lower extremity intraoperative peripheral nerve injury related to lithotomy positioning. The overall incidence of intraoperative peripheral nerve injury in robotic-assisted laparoscopic urologic, gynaecologic and colorectal surgery was 0.16%-10.0% and the symptoms appeared immediately after surgical procedures. Risk factors for intraoperative peripheral injury were prolonged operative time, high American Society of Anesthesiologists scores, comorbidities and high body mass index. CONCLUSION Intraoperative peripheral nerve injuries are rare, but occasionally serious when related to lithotomy positioning with steep Trendelenburg. Operating room nurses have a responsibility both for positioning patients and for being familiar with the technological developments that will influence the preoperative handling of patients. IMPACT This systematic review emphasizes the need for operating room nurses together with surgical team to have knowledge about mechanisms for injury, positioning, anatomy/physiology, and evaluation of risk factors to ensure that patients are not exposed for intraoperative peripheral nerve injuries. Increased robotic-assisted laparoscopic surgery necessitates further research examining the incidence of intraoperative peripheral nerve injury related to positioning and how these affect patients' function and the quality of life.
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Affiliation(s)
- Benedikte Bjøro
- Department of Operating Services, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Ida Mykkeltveit
- Faculty of Health Science, University of Stavanger, Stavanger, Norway
| | - Tone Rustøen
- Department of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Bahar Candas Altinbas
- Department of Surgical Disease Nursing, Faculty of Health Science, Karadeniz Technical University, Trabzon, Turkey
| | - Olav Røise
- Division of Orthopedics Surgery, Faculty of health Sciences, Oslo University Hospital, SHARE-Center for Resilience in Healthcare, University of Stavanger, Stavanger, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Signe Berit Bentsen
- Department of Operating Services, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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24
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Cimen HI, Atik YT, Altinova S, Adsan O, Balbay MD. Does the experience of the bedside assistant effect the results of robotic surgeons in the learning curve of robot assisted radical prostatectomy? Int Braz J Urol 2019; 45:54-60. [PMID: 30521164 PMCID: PMC6442128 DOI: 10.1590/s1677-5538.ibju.2018.0184] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/26/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction: The success of the robot assisted radical prostatectomy (RARP) procedures depend on a successful team, however the literature focuses on the performance of a console surgeon. The aim of this study was to evaluate surgical outcomes of the surgeons during the learning curve in relation to the bedside assistant's experience level during RARP. Materials and Methods: We retrospectively reviewed two non - laparoscopic, beginner robotic surgeon's cases, and we divided the patients into two groups. The first surgeon completed the operations on 20 patients with a beginner bedside assistant in February - May 2009 (Group-1). The second surgeon completed operations on 16 patients with an experienced (at least 150 cases) bedside assistant in February 2015 - December 2015 (Group-2). The collected data included age, prostate volume, prostate specific antigen (PSA), estimated blood loss, complications and percent of positive surgical margins. In addition, the elapsed time for trocar insertion, robot docking, console surgery, specimen extraction and total anesthesia time were measured separately. Results: There were no significant differences between the groups in terms of age, comorbidity, prostate volume, PSA value, preoperative Gleason score, number of positive cores, postoperative Gleason score, pathological grade, protection rate of neurovascular bundles, surgical margin positivity, postoperative complications, length of hospital stay, or estimated blood loss. The robot docking, trocar placement, console surgery, anesthesia and specimen extraction times were significantly shorter in group 2 than they were in group 1 (17.75 ± 3.53 min vs. 30.20 ± 7.54 min, p ≤ 0.001; 9.63 ± 2.71 min vs. 14.40 ± 4.52 min, p = 0.001; 189.06 ± 27.70 min vs. 244.95 ± 80.58 min, p = 0.01; 230.94 ± 30.83 min vs. 306.75 ± 87.96 min, p = 0.002; 10.19 ± 2.54 min vs. 17.55 ± 8.79 min, p = 0.002; respectively). Conclusion: Although the bedside assistant's experience in RARP does not appear to influence the robotic surgeon's oncological outcomes during the learning curve, it may reduce the potential complications by shortening the total operation time.
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Affiliation(s)
- Haci Ibrahim Cimen
- Department of Urology, Sakarya University, School of Medicine, Sakarya, Turkey
| | - Yavuz Tarik Atik
- Department of Urology, Sakarya University, School of Medicine, Sakarya, Turkey
| | - Serkan Altinova
- Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Oztug Adsan
- Department of Urology, Sakarya University, School of Medicine, Sakarya, Turkey
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25
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Johansson VR, von Vogelsang A. Patient‐reported extremity symptoms after robot‐assisted laparoscopic cystectomy. J Clin Nurs 2019; 28:1708-1718. [DOI: 10.1111/jocn.14781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/28/2018] [Accepted: 12/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Ann‐Christin von Vogelsang
- Theme Neuro Karolinska University Hospital Stockholm Sweden
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
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26
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Souki FG, Rodriguez-Blanco YF, Polu SR, Eber S, Candiotti KA. Survey of anesthesiologists' practices related to steep Trendelenburg positioning in the USA. BMC Anesthesiol 2018; 18:117. [PMID: 30131061 PMCID: PMC6104011 DOI: 10.1186/s12871-018-0578-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 08/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Steep Trendelenburg during surgery has been associated with many position-related injuries. The American Society of Anesthesiology practice advisory recommends documentation, frequent position checks, avoiding shoulder braces, and limiting abduction of upper extremities to avoid brachial plexopathy. We conducted a web-based survey to assess anesthesiologists' practices, institutional policies, and complications encountered when using steep Trendelenburg. METHODS Two thousand fifty randomly selected active members of the American Society of Anesthesiology were invited via email to participate in a 9-item web-based survey. Results are reported as absolute numbers and proportions with 95% confidence interval (CI). RESULTS Survey response rate was 290 of 2050 (14.1%). 44.6% (95% CI, 38.9-50.3) of the respondents documented anesthesia start and finish, 73.9% (95% CI, 68.8-79) frequently checked positioning during surgery, 30.8% (95% CI, 25.4-36.2) reported using shoulder braces, 66.9% (95% CI, 61.5-72.3) tucked patients' arms to the side, 54.0% (95% CI, 48.2-59.8) limited fluid administration, and more than two-thirds did not limit the duration or inclination angle. Notably, 63/290 (21.7%) reported a complication and only 6/289 (2.1%) had an institutional policy. The most common complication was airway and face edema, second was brachial plexus injury, and third was corneal abrasions. Most institutional policies, when present, focused on limiting duration of steep Trendelenburg and communication with surgical team. Only 1/6 policies required avoiding use of shoulder braces. CONCLUSION Based on survey results, practices related to steep Trendelenburg varied among USA anesthesiologists. Differences included protective measures, documentation, positioning techniques, fluid management, and institutional guidelines. The singular commonality found among all respondents was lack of institutional policies. Survey results highlighted the need for institutional policies and more education.
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Affiliation(s)
- Fouad G Souki
- Department of Anesthesiology, Jackson Memorial Hospital, University of Miami/Jackson Health System, 1611 NW 12th Ave, DTC 318, Miami, FL, 33136, USA.
| | - Yiliam F Rodriguez-Blanco
- Department of Anesthesiology, Jackson Memorial Hospital, University of Miami/Jackson Health System, 1611 NW 12th Ave, DTC 318, Miami, FL, 33136, USA
| | - Sravankumar Reddy Polu
- Department of Anesthesiology, Jackson Memorial Hospital, University of Miami/Jackson Health System, 1611 NW 12th Ave, DTC 318, Miami, FL, 33136, USA
| | - Scott Eber
- Department of Anesthesiology, Jackson Memorial Hospital, University of Miami/Jackson Health System, 1611 NW 12th Ave, DTC 318, Miami, FL, 33136, USA
| | - Keith A Candiotti
- Department of Anesthesiology, Jackson Memorial Hospital, University of Miami/Jackson Health System, 1611 NW 12th Ave, DTC 318, Miami, FL, 33136, USA
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27
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Abstract
Over the past decade there has been an exponential increase in the number of robotic-assisted surgical procedures performed in Australia and internationally. Despite this growth, there are no level I or II studies examining the anaesthetic implications of these procedures. Available observational studies provide insight into the significant challenges for the anaesthetist. Most anaesthetic considerations overlap with those of non-robotic surgery. However, issues with limited patient access and extremes of positioning resulting in physiological disturbances and risk of injury are consistently demonstrated concerns specific to robotic-assisted procedures.
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28
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Duffy BJ, Tubog TD. The Prevention and Recognition of Ulnar Nerve and Brachial Plexus Injuries. J Perianesth Nurs 2017; 32:636-649. [PMID: 29157770 DOI: 10.1016/j.jopan.2016.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 05/10/2016] [Accepted: 06/04/2016] [Indexed: 11/19/2022]
Abstract
Perioperative peripheral nerve injury is a serious yet preventable perioperative complication. Since the inception of the American Association of Anesthesiologists Closed Claim Project, the incidence of peripheral nerve injury has remained constant with an overall reported prevalence rate of 15% to 16%. To date, the most frequent nerve injuries are ulnar nerve neuropathy and brachial plexus injury. This article will review the clinical presentation, pathophysiology, causative and risks factors, and preventive measures for the two most common nerve injuries. Knowledge of the anatomical structures and components of peripheral nerves prone to injuries during surgery can assist in defining precautionary actions in the perioperative setting. Positioning techniques in the operating room, early recognition of neuropathies, and use of a perioperative tool in the postoperative setting are keys to reduce significant clinical complications.
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29
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Zillioux JM, Krupski TL. Patient positioning during minimally invasive surgery: what is current best practice? ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:69-76. [PMID: 30697565 PMCID: PMC6193419 DOI: 10.2147/rsrr.s115239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction Positioning injuries are a known surgical complication and can result in significant patient morbidity. Studies have shown a small but significant number of neurovascular injuries associated with minimally invasive surgery, due to both patient and case-specific factors. We sought to review the available literature in regards to pathophysiological and practical recommendations. Methods A literature search was conducted and categorized by level of evidence, with emphasis on prospective studies. The result comprised 14 studies, which were summarized and analyzed with respect to our study objectives. Results While incidence of positioning injury has been identified in up to one-third of prospective populations, its true prevalence after surgery is likely 2%-5%. The mechanism is thought to be intraneural disruption from stretching or pressure, which results in decreased perfusion. On a larger scale, this vascular compromise can lead to ischemia and rhabdomyolysis. Prevention hinges on addressing patient modifiable factors such as body mass index, judicious positioning with appropriate devices, and intraoperative team awareness consisting of recurrent extremity checks and time management. Conclusion The risk for positioning injuries is underappreciated. Surgeons who perform minimally invasive surgery should discuss the potential for these complications with their patients, and operative teams should take steps to minimize risk factors.
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Affiliation(s)
| | - Tracey L Krupski
- Department of Urology, University of Virginia, Charlottesville, VA, USA,
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30
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Ginsburg KB, Pape K, Heilbronn C, Levin M, Cher ML. Prospective assessment of positioning-related pain in robotic urologic surgery. J Robot Surg 2017; 12:97-101. [PMID: 28470407 DOI: 10.1007/s11701-017-0701-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 04/24/2017] [Indexed: 11/27/2022]
Abstract
This was a prospective study to assess positioning-related pain in 20 awake volunteers in the dorsal lithotomy (DL) and lateral decubitus (LD) positions. Each volunteer was put through the series of discrete, sequential steps used to achieve a final position; each step had two options. The Wong-Baker scale (WB) was used to rate pain for each option and the preferred option and ad lib comments were recorded. We found that awake volunteers could clearly and immediately distinguish differences in pain levels between position options. For the DL position, volunteers favored having the arms slightly flexed and pronated as opposed to being straight and supinated reflected by statistically less painful WB scores and option preference. Volunteers preferred having the neck flexed as opposed to being flat. For the LD position, volunteers reported statistically lower pain scores and preference for a foam roll for axilla support as opposed to a rolled blanket, the table flexed without the kidney rest as opposed to a raised kidney rest, and the over arm board as oppose to stacked blankets for contralateral arm support. Ad lib comments from the volunteers supported the above findings. To our knowledge, ours is the first study to demonstrate objective preferences for variations in surgical positioning using awake volunteers. This exercise with awake volunteers resulted in immediate changes in positioning for real robotic surgery patients in our practice.
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Affiliation(s)
- Kevin B Ginsburg
- Department of Urology, University Health Center, Wayne State University School of Medicine, 4201 St. Antoine, Ste 7-C, Detroit, MI, 48201, USA.
| | - Kelsey Pape
- Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI, 48201, USA
| | - Chase Heilbronn
- Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI, 48201, USA
| | - Michael Levin
- Department of Urology, University Health Center, Wayne State University School of Medicine, 4201 St. Antoine, Ste 7-C, Detroit, MI, 48201, USA
| | - Michael L Cher
- Department of Urology, University Health Center, Wayne State University School of Medicine, 4201 St. Antoine, Ste 7-C, Detroit, MI, 48201, USA
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Maerz D, Beck L, Sim A, Gainsburg D. Complications of robotic-assisted laparoscopic surgery distant from the surgical site. Br J Anaesth 2017; 118:492-503. [DOI: 10.1093/bja/aex003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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32
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[Interest of surgical companionship during the training period of robot-assisted radical prostatectomy]. Prog Urol 2017; 27:297-304. [PMID: 28258911 DOI: 10.1016/j.purol.2017.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 12/28/2016] [Accepted: 01/24/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Study of the learning curve of robot-assisted radical prostatectomy, evaluating intraoperative difficulties and postoperative complications according to Clavien-Dindo classification. PATIENTS AND METHODS Retrospective study of our first 157 consecutive patients treated with robot-assisted prostatectomy for localized prostate cancer between September 2011 and December 2014. Comparison of learning for each group of 50 procedures and then comparison between patients operated on by a pair of two seniors specially trained for robotic surgery and patients operated on by one mixed pair including a surgeon junior coached by one senior of the first group. RESULTS Only postoperative complications decreased significantly from the 51st patient (P=0.04). The curves showing the evolution of the operative time decreased with a parallel trend between the two pairs, but with more variability in the mixed pair. There was no significant difference in terms of intraoperative difficulties (P=0.59), nor postoperative complications (P=0.56) mainly of grade 2. The blood loss, transfusion rate, duration of hospitalization and readmission rates did not differ. Lymph node dissection did not affect outcomes. For oncological results, the overall rate of positive surgical margins (R+) was 30.6 % in the initial pair against 24.2 % in the mixed group with no significant difference. Nevertheless, the subpopulation study objectified a R+ rate of 12.86 % for pT2 against 42.85 % for pT3. CONCLUSION The early involvement of a junior surgeon who did not receive specific training, but benefiting from the guidance of a senior surgeon, did not compromise the results while allowing a faster learning curve with a rate of operative complications close to the one observed by the senior pair. LEVEL OF EVIDENCE 4.
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Kohli M, Panday BC, Sood J. Smart Phones Application for Intraoperative Patient Care. Anesth Analg 2017; 124:1731-1732. [PMID: 28207590 DOI: 10.1213/ane.0000000000001941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Manish Kohli
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India,
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34
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Lee JW, Kim MK, Kang HY, Kim Y. Transparent acrylic protector use for patient positioning and monitoring in robot-assisted laparoscopic prostatectomy. Br J Anaesth 2017; 118:271-272. [PMID: 28100536 DOI: 10.1093/bja/aew460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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35
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Vahlensieck W, Hoffmann W, Zermann DH. [Social medicine assessment after surgical and targeted treatment of renal cell cancer]. Urologe A 2016; 55:1601-1604. [PMID: 27306354 DOI: 10.1007/s00120-016-0159-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In Germany, renal cell cancer counts for 2.5 % of all carcinomas in women and 3.5 % in men. Curative therapy ensures good chances of recovery. But there might be permanent complications like renal insufficiency, pain, incisional hernia, flank muscle relaxation, and paresis. In addition, targeted therapy is associated with several potential side effects. In both therapy groups, severe psychological problems may occur. Still employed patients with these problems must be examined by an expert to estimate the possibilities of returning to working (positive scope of work) and occupations which can not be performed anymore (negative scope of work).
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Affiliation(s)
- W Vahlensieck
- Fachklinik Urologie, Kurpark-Klinik, Kurstr. 41-45, 61231, Bad Nauheim, Deutschland.
| | - W Hoffmann
- Fachklinik für onkologische Rehabilitation und Anschlussrehabilitation (AHB), Klinik Park-Therme, Badenweiler, Deutschland
| | - D-H Zermann
- Fachklinik für Urologie, Uroonkologie und Nephrologie, Rehabilitationszentrum Vogtland-Klinik, Bad Elster, Deutschland
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36
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Yamada Y, Fujimura T, Fukuhara H, Miyagawa J, Miyazaki H, Nakagawa T, Kume H, Homma Y. Measuring Contact Pressure of Lower Extremities in Patients Undergoing Robot-Assisted Radical Prostatectomy. Urol Int 2016; 96:268-73. [DOI: 10.1159/000443335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 12/11/2015] [Indexed: 11/19/2022]
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37
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Christie MC, Manger JP, Khiyami AM, Ornan AA, Wheeler KM, Schenkman NS. Occult Radiographically Evident Port-Site Hernia After Robot-Assisted Urologic Surgery: Incidence and Risk Factors. J Endourol 2016; 30:92-6. [DOI: 10.1089/end.2015.0431] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Matthew C. Christie
- Department of Urology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Jules P. Manger
- Department of Urology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Abdulaziz M. Khiyami
- Department of Radiology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Afshan A. Ornan
- Department of Radiology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Karen M. Wheeler
- Department of Urology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Noah S. Schenkman
- Department of Urology, University of Virginia School of Medicine, Charlottesville, Virginia
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Talab SS, Elmi A, Sarma J, Barrisford GW, Tabatabaei S. Safety and Effectiveness of SAF-R, a Novel Patient Positioning Device for Robot-Assisted Pelvic Surgery in Trendelenburg Position. J Endourol 2015; 30:286-92. [PMID: 26531773 DOI: 10.1089/end.2015.0601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We found current robotic positioning devices to be inadequate and cumbersome. Furthermore, we realized there were no premarket well-designed studies to prove their safety and efficacy. In this prospective pilot study, we aimed to investigate the safety and effectiveness of a novel patient-positioning device (SAF-R) to secure the patient in Trendelenburg (T-burg) position for robot-assisted pelvic surgery. PATIENTS AND METHODS Sixteen patients undergoing robot-assisted pelvic operation in T-burg position were enrolled. Patients were positioned using SAF-R board. Pressure sensor mats were used for real-time monitoring of the contact pressures and contact area on the shoulders and calves throughout the surgery. Data collection included patients' body mass index (BMI), time needed for positioning, total time in the T-burg position, contact pressure and contact area readings from the sensor mats, and the patient shifting distance on the table. Patients were also followed for 1-month postoperatively for any position-related adverse event. RESULTS The median age of the patients was 56.5 years with median BMI of 27.3. The median positioning time was 6 minutes, duration of T-burg position was 3.5 hours, and patient shift on the table was 1 cm. The contact pressure over the shoulders was in the safe range (< 80 mm Hg) before and at the end of the surgery in all cases (right: 13.12 ± 1.12 vs 20.25 ± 1.56 mm Hg, left: 12.84 ± 1.05 vs 19.60 ± 1.09 mm Hg, p = 0.001). The changes in the mean contact pressure over the calves and the mean contact area for the shoulders and calves during the T-burg position were not significantly different. No significant position-related complication was detected during follow-up. CONCLUSIONS SAF-R surgical board is a safe, reliable, and timesaving positioning device for patients undergoing robotic pelvic surgery in the T-burg position.
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Affiliation(s)
- Saman S Talab
- 1 Department of Urology, Massachusetts General Hospital , Harvard Medical School, Boston, Massachusetts
| | - Azadeh Elmi
- 1 Department of Urology, Massachusetts General Hospital , Harvard Medical School, Boston, Massachusetts
| | - Jaydev Sarma
- 2 Department of Anesthesiology, Massachusetts General Hospital , Harvard Medical School, Boston, Massachusetts
| | - Glen W Barrisford
- 1 Department of Urology, Massachusetts General Hospital , Harvard Medical School, Boston, Massachusetts
| | - Shahin Tabatabaei
- 1 Department of Urology, Massachusetts General Hospital , Harvard Medical School, Boston, Massachusetts
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39
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Gezginci E, Ozkaptan O, Yalcin S, Akin Y, Rassweiler J, Gozen AS. Postoperative pain and neuromuscular complications associated with patient positioning after robotic assisted laparoscopic radical prostatectomy: a retrospective non-placebo and non-randomized study. Int Urol Nephrol 2015; 47:1635-41. [DOI: 10.1007/s11255-015-1088-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 08/14/2015] [Indexed: 10/23/2022]
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40
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Transient Left-Sided Paralysis following Robotic-Assisted Laparoscopic Uteropexy. Case Rep Anesthesiol 2015; 2015:150715. [PMID: 26101671 PMCID: PMC4460200 DOI: 10.1155/2015/150715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/15/2015] [Accepted: 05/17/2015] [Indexed: 01/17/2023] Open
Abstract
We describe a case report of a 47-year-old ASA 2 female patient who exhibits severe headache and hemineurology during awakening following robotic pelvic prolapse surgery. The symptoms resolved spontaneously during the first postoperative day. We could not find any explicit root cause. Robotic surgery associated adverse events are discussed.
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Tamkus AA, Scott AF, Khan FR. Neurophysiological Monitoring During Spinal Cord Stimulator Placement Surgery. Neuromodulation 2015; 18:460-4; discussion 464. [DOI: 10.1111/ner.12273] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 11/24/2014] [Accepted: 12/26/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Fahd R. Khan
- Department of Neurosurgery; Stanford University; Stanford CA USA
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The diffusion of minimally invasive radical prostatectomy in the United States: a case study of the introduction of new surgical devices. Prostate Cancer Prostatic Dis 2014; 18:75-80. [DOI: 10.1038/pcan.2014.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 10/22/2014] [Accepted: 10/25/2014] [Indexed: 11/08/2022]
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Wen T, Deibert CM, Siringo FS, Spencer BA. Positioning-related complications of minimally invasive radical prostatectomies. J Endourol 2014; 28:660-7. [PMID: 24428586 DOI: 10.1089/end.2013.0623] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE Because of recent advances in minimally invasive surgical techniques, robot-assisted radical prostatectomy (RARP) has become the primary treatment option in prostate cancer. RARP, however, necessitates patients to be placed in a steep Trendelenberg position, which presents multiple opportunities for complications relating to the positioning of the patient. Our study aims to study the prevalence and demographic predictors of these positioning complications and assess their impacts on length of stay (LOS) and total cost. PATIENTS AND METHODS We included patients who underwent RP from 2008 to 2009 using data extracted from the Nationwide Inpatient Sample database. Positioning complications (eye, nerve, compartment syndrome/rhabdomyolysis) were identified using patient-level diagnosis and procedural International Classification of Disease, 9th edition, Clinical Modification codes. Logistic regression models assessed relationships between demographic factors and occurrence of complications and the effects of them on prolonged LOS and total inpatient cost. RESULTS Positioning complications occurred in 0.4% of cases with eye complications contributing the most to this frequency. Laparoscopic RP procedure (odds ratio [OR]=2.88, P<0.01) and comorbidities (OR=2.34, P<0.01) were highly associated with increased odds of positioning complication occurrence, whereas RARP procedures (OR=0.93, P>0.4) were not associated with positioning complications. Having positioning complications increased a patient's odds of having increased inpatient costs and extended LOS by almost 400% and 300%, respectively. CONCLUSION The steep Trendelenberg position used in RARP was not shown to be associated with patient positioning-related complications in this sample. The occurrence of positioning-related complications, however, places huge burdens on total inpatient costs and LOS.
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Affiliation(s)
- Timothy Wen
- 1 Department of Epidemiology, Mailman School of Public Health, Columbia University , New York, New York
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Patient Positioning and Prevention of Injuries in Patients Undergoing Laparoscopic and Robot-Assisted Urologic Procedures. Curr Urol Rep 2014; 15:398. [DOI: 10.1007/s11934-014-0398-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Lee JR. Anesthetic considerations for robotic surgery. Korean J Anesthesiol 2014; 66:3-11. [PMID: 24567806 PMCID: PMC3926998 DOI: 10.4097/kjae.2014.66.1.3] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 10/29/2013] [Indexed: 01/22/2023] Open
Abstract
Recently, demand for minimally invasive surgery has increased greatly. As a result, robot-assisted techniques have gained in popularity, because they overcome several of the shortcomings of conventional laparoscopic techniques. However, robotic surgery may require innovations with regard to patient positioning and the overall arrangement of operative equipment and personnel, which may go against the conservative nature of anesthesia care. Anesthesiologists should become familiar with these changes by learning the basic features of robotic surgical systems to offer better anesthetic care and promote patient safety.
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Affiliation(s)
- Jeong Rim Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea. ; Anesthesia and Pain Research Institute, Seoul, Korea
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Carter SC, Lipsitz S, Shih YCT, Nguyen PL, Trinh QD, Hu JC. Population-based determinants of radical prostatectomy operative time. BJU Int 2014; 113:E112-8. [DOI: 10.1111/bju.12451] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Stacey C. Carter
- Department of Urology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
| | - Stuart Lipsitz
- Center for Surgery and Public Health; Brigham and Women's Hospital; Boston MA USA
| | - Ya-Chen T. Shih
- Department of Medicine; University of Chicago; Chicago IL USA
| | - Paul L. Nguyen
- Department of Radiation Oncology; Brigham and Women's Hospital; Boston MA USA
| | - Quoc-Dien Trinh
- Department of Surgery; Division of Urology; Brigham and Women's Hospital; Boston MA USA
- Dana Farber Cancer Institute; Harvard Medical School; Boston MA USA
| | - Jim C. Hu
- Department of Urology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
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Song JB, Vemana G, Mobley JM, Bhayani SB. The second "time-out": a surgical safety checklist for lengthy robotic surgeries. Patient Saf Surg 2013; 7:19. [PMID: 23731776 PMCID: PMC3689613 DOI: 10.1186/1754-9493-7-19] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 05/30/2013] [Indexed: 11/10/2022] Open
Abstract
Robotic surgeries of long duration are associated with both increased risks to patients as well as distinct challenges for care providers. We propose a surgical checklist, to be completed during a second "time-out", aimed at reducing peri-operative complications and addressing obstacles presented by lengthy robotic surgeries. A review of the literature was performed to identify the most common complications of robotic surgeries with extended operative times. A surgical checklist was developed with the goal of addressing these issues and maximizing patient safety. Extended operative times during robotic surgery increase patient risk for position-related complications and other adverse events. These cases also raise concerns for surgical, anesthesia, and nursing staff which are less common in shorter, non-robotic operations. Key elements of the checklist were designed to coordinate operative staff in verifying patient safety while addressing the unique concerns within each specialty. As robotic surgery is increasingly utilized, operations with long surgical times may become more common due to increased case complexity and surgeons overcoming the learning curve. A standardized surgical checklist, conducted three to four hours after the start of surgery, may enhance perioperative patient safety and quality of care.
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Affiliation(s)
- Joseph B Song
- Washington University in St, Louis School of Medicine, 4960 Children's Place, Campus Box 8242, St, Louis, MO 63110, USA.
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Risk factors for positioning injury during robotic surgery. Nat Rev Urol 2013. [DOI: 10.1038/nrurol.2013.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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