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Piozzi GN, Przedlacka A, Duhoky R, Ali O, Ghanem Y, Beable R, Higginson A, Khan JS. Robotic transanal minimally invasive surgery (r-TAMIS): perioperative and short-term outcomes for local excision of rectal cancers. Surg Endosc 2024; 38:3368-3377. [PMID: 38710889 PMCID: PMC11133047 DOI: 10.1007/s00464-024-10829-4] [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: 01/09/2024] [Accepted: 03/23/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Transanal minimally invasive surgery (TAMIS) is an advanced technique for excision of early rectal cancers. Robotic TAMIS (r-TAMIS) has been introduced as technical improvement and potential alternative to total mesorectal excision (TME) in early rectal cancers and in frail patients. This study reports the perioperative and short-term oncological outcomes of r-TAMIS for local excision of early-stage rectal cancers. METHODS Retrospective analysis of a prospectively collected r-TAMIS database (July 2021-July 2023). Demographics, clinicopathological features, short-term outcomes, recurrences, and survival were investigated. RESULTS Twenty patients were included. Median age and body mass index were 69.5 (62.0-77.7) years and 31.0 (21.0-36.5) kg/m2. Male sex was prevalent (n = 12, 60.0%). ASA III accounted for 66.7%. Median distance from anal verge was 7.5 (5.0-11.7) cm. Median operation time was 90.0 (60.0-112.5) minutes. Blood loss was minimal. There were no conversions. Median postoperative stay was 2.0 (1.0-3.0) days. Minor and major complication rates were 25.0% and 0%, respectively. Seventeen (85.0%) patients had an adenocarcinoma whilst three patients had an adenoma. R0 rate was 90.0%. Most tumours were pT1 (55.0%), followed by pT2 (25.0%). One patient (5.0%) had a pT3 tumour. Specimen and tumour maximal median diameter were 51.0 (41.0-62.0) mm and 21.5 (17.2-42.0) mm, respectively. Median specimen area was 193.1 (134.3-323.3) cm2. Median follow-up was 15.5 (10.0-24.0) months. One patient developed local recurrence (5.0%). CONCLUSIONS r-TAMIS, with strict postoperative surveillance, is a safe and feasible approach for local excision of early rectal cancer and may have a role in surgically unfit and elderly patients who refuse or cannot undergo TME surgery. Future prospective multicentre large-scale studies are needed to report the long-term oncological outcomes.
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Affiliation(s)
| | - Ania Przedlacka
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Rauand Duhoky
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Oroog Ali
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- Department of General Surgery, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Yasser Ghanem
- Department of General Surgery, Isle of Wight NHS Trust, Newport, UK
| | - Richard Beable
- Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Antony Higginson
- Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Jim S Khan
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
- University of Portsmouth, Portsmouth, UK.
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Ochi T, Katsuno H, Kato H, Takagi S, Kikuchi K, Nakamura K, Endo T, Matsuo K, Yasuoka H, Nishimura A, Horiguchi A, Morise Z. Preliminary comparative study of lower extremity pressure measurements under the conditions using former models and new lithotomy stirrups in rectal cancer surgery. World J Surg Oncol 2024; 22:85. [PMID: 38566192 PMCID: PMC10988980 DOI: 10.1186/s12957-024-03352-2] [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: 10/25/2023] [Accepted: 02/24/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND This study aimed to investigate the effect of the use of new lithotomy stirrups-2 on the pressure dispersal on lower limbs, which may lead to the prevention of well-leg compartment syndrome (WLCS) and deep venous thrombosis (DVT), which are the most commonly associated adverse events with laparoscopic and robot-assisted rectal surgery. METHODS A total of 30 healthy participants were included in this study. The pressure (mmHg) applied on various lower limb muscles when using conventional lithotomy stirrups-1 and new type stirrups-2 was recorded in various lithotomy positions; 1) neutral position, 2) Trendelenburg position (15°) with a 0° right inferior tilt, and 3) Trendelenburg position (15°) with a 10° right inferior tilt. Using a special sensor pad named Palm Q®, and the average values were compared between two types of stirrups. RESULTS The use of new lithotomy stirrups-2 significantly reduced the pressure applied on the lower limb muscles in various lithotomy positions compared with the use of lithotomy stirrups-1. The most pressured lower limb muscle when using both lithotomy stirrups was the central soleus muscle, which is the most common site for the development of WLCS and DVT. In addition, when using the conventional lithotomy stirrups-1, the pressure was predominantly applied to the proximal soleus muscle; however, when using lithotomy stirrups-2, the pressure was shifted to the more distal soleus muscle. CONCLUSION These results suggest that the new lithotomy stirrups-2 is useful in reducing the pressure load on leg muscles, especially on the proximal to central soleus, and may reduce the incidence of WLCS and DVT after rectal surgery performed in the lithotomy position. Further clinical studies are needed to determine whether the use of lithotomy stirrups-2 prevents these complications in various clinical settings.
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Affiliation(s)
- Takayuki Ochi
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, Nagoya, Japan
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan.
| | - Hiroyuki Kato
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, Nagoya, Japan
| | - Shinya Takagi
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Kenji Kikuchi
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Kenichi Nakamura
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Kazuhiro Matsuo
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Hironobu Yasuoka
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, Nagoya, Japan
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Akihiro Nishimura
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Akihiko Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, Nagoya, Japan
| | - Zenichi Morise
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
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Sauliunaite V, Vecsernyés N, Coronado M. Acute lumbar paraspinal compartment syndrome after radical cystectomy. BMJ Case Rep 2024; 17:e255983. [PMID: 38569733 PMCID: PMC10989141 DOI: 10.1136/bcr-2023-255983] [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] [Accepted: 03/14/2024] [Indexed: 04/05/2024] Open
Abstract
Lumbar paraspinal compartment syndrome (LPCS) is a rare diagnosis, seen in patients chronically after repeated lumbar trauma or acutely in a postoperative setting. Only a dozen cases are documented worldwide, and to date no clinical guidelines exist for the diagnosis nor the treatment.We describe the case of a 44-year-old man with excruciating lower back pain following a radical cystectomy. The postoperative laboratory values were compatible with acute rhabdomyolysis. The lumbar spine MRI showed necrosis of lumbosacral paraspinal muscles, making the diagnosis of acute LPCS. After seeking advice from different specialists, the conservative approach was chosen with combined pain treatment and physiotherapy. The patient is currently still disabled for some tasks and needs chronic pain medication.
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Affiliation(s)
- Vilte Sauliunaite
- Emergency Department, Riviera-Chablais Hospital, 1847 Rennaz, Switzerland
| | - Noémie Vecsernyés
- Department of Acute Medicine, Division of Intensive Care, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Marcos Coronado
- Department of Critical Care, Riviera-Chablais Hospital, 1847 Rennaz, Switzerland
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Yukizawa Y, Kamono E, Takagawa S, Hirotomi K, Higashihira S, Choe H, Inaba Y, Kobayashi N. Evaluation of the Postoperative Risk of Deep Tissue Injury to the Lower Extremities Following Surgery in the Lithotomy Position. Cureus 2024; 16:e57413. [PMID: 38694644 PMCID: PMC11062756 DOI: 10.7759/cureus.57413] [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: 04/01/2024] [Indexed: 05/04/2024] Open
Abstract
Background The aim of this study was to determine the incidence of deep tissue injury (DTI) and potential risk factors after surgery in the lithotomy position. Methods All patients who underwent surgery in the lithotomy position under general anesthesia at a single center between January 2017 and December 2021 were retrospectively evaluated. The medical records of these patients were reviewed, and patient demographic and clinical characteristics, surgical data, and occurrence of DTI were recorded. Results During the study period, 5146 patients, 2055 (39.9%) males and 3091 (60.1%) females, with a mean age of 57.3 ± 17.4 years, underwent surgery in the lithotomy position. Seven (0.14%) patients developed DTI on their calf following surgery. All presented with severe pain and swelling, requiring prolonged hospital stay. Multivariate analysis showed that male sex (odds ratio (OR): 11.43; 95% confidence interval (CI): 1.15-113.34, p = 0.037), higher BMI (OR: 1.32; 95% CI: 1.17-1.50, p = 0.0001), and longer operation time (OR: 1.01; 95% CI: 1.004-1.014, p = 0.0002) were independent risk factors for postoperative DTI. Optimal cut-off values for BMI and operation time were 23.5 kg/m2 (sensitivity = 100%; specificity = 64%) and 285 minutes (sensitivity = 100%; specificity = 90%), respectively. Conclusion Factors significantly associated with DTI include male sex, higher BMI, and prolonged operation time.
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Affiliation(s)
- Yohei Yukizawa
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Emi Kamono
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Shu Takagawa
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Kunihito Hirotomi
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Shota Higashihira
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Hyonmin Choe
- Orthopaedic Surgery, Yokohama City University, Yokohama, JPN
| | - Yutaka Inaba
- Orthopaedic Surgery, Yokohama City University, Yokohama, JPN
| | - Naomi Kobayashi
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
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Zhang LL, Luo ZF, Yang GJ. A Randomized Controlled Comparative Study of the Three Over-Bed Techniques for Positioning and Repositioning the Lithotomy Position While Using Stirrups. J Multidiscip Healthc 2023; 16:4255-4264. [PMID: 38164462 PMCID: PMC10758315 DOI: 10.2147/jmdh.s435570] [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: 09/15/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
Objective In this study, the clinical application and efficacy of three different methods for placing and repositioning patients in the lithotomy position over the bed using stirrups were evaluated. Methods A total of 240 surgical patients who underwent surgery in Chongqing Traditional Chinese Medicine Hospital between July and November 2022 were selected as study participants. Using envelopes, they were randomly divided into three groups of 80 cases each using a randomization method. The groups included the traditional over-bed method, the postural trolley-assisted over-bed method, and the direct over-bed method. Using the Kruskal-Wallis rank-sum test, analysis of variance, and multiple linear regression equations, the placement time, over-bed repositioning time, and total time of the three methods for placing and repositioning in the lithotomy position supported by stirrups were analyzed statistically. In addition, we investigated and examined the satisfaction of nurses and doctors with the aforementioned techniques. Results The placement time, repositioning time, and total time were significantly higher for the traditional over-bed method than for the postural trolley-assisted over-bed method and the direct over-bed method (both P < 0.01). However, there was no statistically significant difference between the postural trolley-assisted over-bed method and the direct over-bed method (P > 0.05). Nurses and doctors reported significantly higher satisfaction with the postural trolley-assisted over-bed method and the direct over-bed method compared to the traditional over-bed method (both P < 0.01). In addition, nurses were more satisfied with the direct over-bed method than the postural trolley-assisted over-bed method (P < 0.05). Conclusion The results of this study demonstrate that the direct over-bed method is preferred for positioning and repositioning patients in the lithotomy position with the support of stirrups.
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Affiliation(s)
- Ling-Ling Zhang
- Hunan University of Chinese Medicine, Hunan, People’s Republic of China
- Department of Operating Room, Chongqing Traditional Chinese Medicine Hospital, Chongqing, People’s Republic of China
| | - Zhi-Fang Luo
- Department of Operating Room, Chongqing Traditional Chinese Medicine Hospital, Chongqing, People’s Republic of China
| | - Guang-Jing Yang
- Hunan University of Chinese Medicine, Hunan, People’s Republic of China
- Department of Nursing, Chongqing Traditional Chinese Medicine Hospital, Chongqing, People’s Republic of China
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Susanne J, Åsa H. Preventing well leg compartment syndrome among patients in the lithotomy position-Operating room nurses' perspectives: A qualitative study. Nurs Open 2023; 10:7092-7101. [PMID: 37571958 PMCID: PMC10495710 DOI: 10.1002/nop2.1971] [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: 12/04/2022] [Revised: 07/12/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
AIM To describe operating room nurses' experiences of well leg compartment syndrome and how they work perioperative to prevent it during the lithotomy position. DESIGN The study had a qualitative design. METHODS Focus group interviews were performed with 10 operating room (OR) nurses. The interviews were semi-structured and analysed by qualitative content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ). RESULTS The main theme showed that the OR nurses shoulder duty and responsibility, independently and in the team, but they need more structural support and knowledge. The themes showed that they follow routines whenever possible and take responsibility for positioning; however, they have to balance between flexibility and strict routines. Although they also develop and participate in teamwork, they still need further knowledge. CONCLUSION The severe complication of well leg compartment syndrome (WLCS) can occur when the patient is in the lithotomy position. Maintaining the same routines and paying attention to the WHO's surgical safety checklist were described as actions that could prevent well leg compartment syndrome. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. We have interviewed nurses but without financial support since the study was performed and supervised within a master programme.
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Well Leg Compartment Syndrome: Pathophysiology, Prevention, and Treatment. J Clin Med 2022; 11:jcm11216448. [DOI: 10.3390/jcm11216448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
The development of compartment syndrome involving the lower limb is a potentially devastating complication of prolonged surgery in patients held in the lithotomy position. Well leg compartment syndrome (WLCS) was recognized in 1953. The incidence of this condition has been reported to range from 0.20% to 0.03%. The mechanism of WLCS development in the absence of trauma appears to be related to prolonged hypoperfusion of the limb, pressure on the muscle compartments, and in some cases, reperfusion of the ischemic limb. This grave complication develops either during or immediately after prolonged surgery in which the patient was held in the Lloyd-Davies lithotomy or hemi-lithotomy position. Surgeons must be aware of the potential for WLCS development during prolonged surgery. Signs of developing WLCS include swelling, increased firmness of the muscle compartments, discoloration, and cooling of the limb. Preventive measures can be taken without contaminating the surgical field by returning the limb to the right atrium level. Once the diagnosis has been made, failure to prevent the development of WLCS requires extensile fasciotomy of each leg compartment to restore perfusion and relieve elevated intra-compartment pressures. This article reviews the pathophysiology, prevention, and treatment of WLCS.
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Hara K, Ichihara K, Yamaguchi M, Takeshita H, Kuroki T. Effect of intraoperative operating table rotation on lower limb perfusion index in patients in the lithotomy position. Medicine (Baltimore) 2022; 101:e30412. [PMID: 36197219 PMCID: PMC9509067 DOI: 10.1097/md.0000000000030677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We focused on "returning to the horizontal position," one of the measures for preventing well leg compartment syndrome implemented at our hospital, and aimed to clarify the effect of intraoperative positional changes by operating table rotation on blood perfusion in the lower extremities during lithotomy in patients under general anesthesia. This prospective observational study examined 64 patients scheduled to undergo general anesthesia in the lithotomy position from March 2021 to May 2022. The primary endpoint was the perfusion index (PI) of the lower limb before and after operating table rotation. The baseline lower limb PI before the operating table rotation was 2.376 (1.591), and the lower limb PI after the change from Trendelenburg to the horizontal position was as follows: immediately after, 2.123 (1.405); 5 minutes, 1.894 (1.138); 10 minutes, 1.915 (1.167); and 15 minutes, 1.993 (1.218). Compared with the baseline, no significant difference was noted in the change in the lower limb PI due to the Trendelenburg to horizontal positional change. The baseline lower leg pressure before the operating table rotation was 51.4 (13.4) mm Hg, and the lower leg pressure after the change from the Trendelenburg to the horizontal position was as follows: immediately after, 36.6 (10.3) mm Hg; 5 minutes, 36.5 (10.2) mm Hg; 10 minutes, 36.4 (10.0) mm Hg; and 15 minutes, 36.5 (10.2) mm Hg. Compared with the baseline, the change in lower leg pressure due to the Trendelenburg to horizontal positional change showed a significant decrease immediately afterward (P < .001). After operating table rotation from the Trendelenburg to the horizontal position, the lower limb PI did not change significantly after 15 min. However, lower leg pressure showed a significant decrease immediately after returning to the horizontal position. This result provides evidence for operating table rotation as a preventive measure for well leg compartment syndrome.
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Affiliation(s)
- Kentaro Hara
- National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- *Correspondence: Kentaro Hara, Department of Operation Center and Department of Nursing, National Hospital Organization Nagasaki Medical Center, Kubara 2-1001-1, Omura, Nagasaki 856-8562, Japan (e-mail: )
| | - Kodai Ichihara
- National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Michiko Yamaguchi
- National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Hiroaki Takeshita
- National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Tamotsu Kuroki
- National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
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