Bilateral brachial plexus injury during laparoscopic sigmoid colectomy

Optimising safe margins in shoulder surgeries: a cadaveric study on brachial plexus nerves with anthropometric and movement correlation

PURPOSE

Shoulder surgeries, vital for diverse pathologies, pose a risk of iatrogenic nerve damage. Existing literature lacks diverse bone landmark-specific nerve position data. The purpose of this study is to address this gap by investigating such relationships.

METHOD

This cadaveric study examines axillary, radial and suprascapular nerves' relation with acromion, coracoid and greater tuberosity of the humerus (GT). It also correlates this data with humeral lengths and explores nerve dynamics in relation to arm positions.

RESULTS

The mean distance from the axillary nerve to (i) GT was 4.38 cm (range 3.32-5.44, SD 0.53), (ii) acromion was 6.42 cm (range 5.03-7.8, SD 0.694) and (iii) coracoid process was 4.3 cm (range 2.76-5.84, SD 0.769). Abduction brought the nerve closer by 0.36 cm, 0.35 cm and 0.53 cm, respectively. The mean distance from radial nerve to (i) GT was 5.46 cm (range 3.78-7.14, SD 0.839), (ii) acromion was 7.82 cm (range 5.4-10.24, SD 1.21) and (iii) tip of the coracoid process was 6.09 cm (range 4.07-8.11 cm, SD 1.01). The mean distance from the suprascapular nerve to the acromion was 4.2 cm (range 3.1-5.4, SD 0.575). The mean humeral length was noted to be 27.83 cm (range 25.3-30.7, SD 1.13). There was no significant correlation between these distances and humeral lengths.

CONCLUSION

It is essential to exercise caution to avoid axillary nerve damage during the abduction manoeuvre, as its distance from the greater tuberosity and tip of the coracoid process has shown a significant reduction. The safe margins, in relation to the length of the humerus and consequently the patient's stature, exhibit no significant variation. In situations where the greater tuberosity (GT) and the border of the acromion are inaccessible due to reasons such as trauma, the tip of the coracoid process can serve as a dependable bone landmark for establishing a secure surgical margin.

Bilateral Post-traumatic Brachial Plexus Injury in an Adult: A Note on the Probable Mechanism of Injury

Bilateral brachial plexus injury is rare following a motor vehicle accident in an adult. We report a 35-year-old man with a bilateral brachial plexus injury. Explaining the mechanism of such an injury is essential to prognosticate the outcome. Fall from the bike, and the position determines the mechanism. The head-shoulder hitting the surface has an avulsion injury (ipsilateral), and the recoiling effect causes traction injury to the contralateral side. Our case had a C5,6 avulsion injury on the right side (ipsilateral) and a C5,6 traction injury (contralateral) to his left side. Surgical exploration and distal nerve transfers were done on the right side. The patient improved his shoulder and elbow function of grade 3, neurolysis of the brachial plexus was done on the left side, and the recovery was complete at 12 months of follow-up.

Position-Related Postoperative Peripheral Neuropathy After Laparoscopic Colorectal Surgery: A Comparative Single-Center Prospective Cohort Study

Background: Laparoscopic colorectal surgery requires perioperative positioning in the dorsal lithotomy position and intermittent Trendelenburg position. This position is associated with postoperative peripheral neuropathy (PPN), which is a substantial cause of anesthesia-related claims. The objective of this study was to assess the incidence of PPN of patients positioned in lithotomy position with shoulder braces, and second to compare this group with patients positioned on the foam mattress Pink Pad^®. Materials and Methods: This consecutive single-center prospective cohort study of 155 patients undergoing colorectal surgery was performed between November 2014 and June 2015. After initial results the implementation of the Pink Pad took place and a total of 52 patients were included between May 2016 and February 2017 to compare the two groups. Results: Positioning with the shoulder brace regimen during laparoscopic colorectal surgery was related to the development of PPN in 33% of cases, as opposed to 15% with Pink Pad. Positioning with shoulder braces increased the risk of PPN with an odds ratio of 3.14 (95% confidence interval: 1.10-8.992) when compared with positioning on Pink Pad. Conclusion: Position-related PPN is an important complication after laparoscopic colorectal surgery. This study concludes that careful attention should be paid to positioning and favors Pink Pad over positioning with shoulder braces. Prolonged time in anesthesia is a predictor of PPN. Clinical Trial Number: H-2-2014-FSP75.

Bilateral Brachial Plexopathy following Laparoscopic Bariatric Surgery

This report describes a case of postoperative bilateral brachial plexopathy following laparoscopic bariatric surgery. The patient, a 39-year-old morbidly obese man, developed motor and sensory deficit, loss of reflexes, and pain in both arms postoperatively. Slow, but complete recovery occurred over nine months. We postulate that the head-up position in obese patients, without specific arm support, is a risk factor for brachial plexus injury.

Intraoperative peripheral nerve injury in colorectal surgery. An update

Intraoperative peripheral nerve injury during colorectal surgery procedures is a potentially serious complication that is often underestimated. The Trendelenburg position, use of inappropriately padded armboards and excessive shoulder abduction may encourage the development of brachial plexopathy during laparoscopic procedures. In open colorectal surgery, nerve injuries are less common. It usually involves the femoral plexus associated with lithotomy position and self-retaining retractor systems. Although in most cases the recovery is mostly complete, treatment consists of physical therapy to prevent muscular atrophy, protection of hypoesthesic skin areas and analgesics for neuropathic pain. The aim of the present study is to review the incidence, prevention and management of intraoperative peripheral nerve injury.

Post-operative brachial plexus neuropraxia: A less recognised complication of combined plastic and laparoscopic surgeries

This presentation is to increase awareness of the potential for brachial plexus injury during prolonged combined plastic surgery procedures. A case of brachial plexus neuropraxia in a 26-year-old obese patient following a prolonged combined plastic surgery procedure was encountered. Nerve palsy due to faulty positioning on the operating table is commonly seen over the elbow and popliteal fossa. However, injury to the brachial plexus has been a recently reported phenomenon due to the increasing number of laparoscopic and robotic procedures. Brachial plexus injury needs to be recognised as a potential complication of prolonged combined plastic surgery. Preventive measures are discussed.

A systematic review of peripheral nerve injury following laparoscopic colorectal surgery

AIM

The risk of peripheral nerve injury associated with laparoscopic colorectal surgery has not been well established. We aimed to identify the number and type of peripheral nerve injuries associated with patient positioning in laparoscopic surgery.

METHOD

A systematic review of MEDLINE and Embase was undertaken of English and non-English language articles. Search terms included the key words: laparoscopic, colorectal, nerve injury, nerve damage, brachial plexus, peripheral neuropathy, peripheral nerve injury, nerve and colonic injury. Articles were included where at least one peripheral nerve injury had been documented related to patient positioning at laparoscopic colorectal surgery. Data extraction for articles was conducted by two authors, using predefined data fields.

RESULTS

Ten cases have been reported in the literature. All injuries involved the brachial plexus. They were associated with a lengthy procedure and abduction of the arm.

CONCLUSION

Although rare, the surgeon and theatre team must be aware of the risk of peripheral nerve injury when positioning patients for laparoscopic colorectal procedures.

Brachial plexus injury following spinal surgery

OBJECT

In the present study, the authors identified the etiology, precipitating factors, and outcomes of perioperative brachial plexus injuries following spine surgery.

METHODS

We reviewed all the available literature regarding postoperative/perioperative brachial plexus injuries, with special concern for the patient's position during surgery, duration of surgery, the procedure performed, neurological outcome, and prognosis. We also reviewed the utility of intraoperative electrophysiological monitoring for prevention of these complications.

RESULTS

Patient malpositioning during surgery is the main determining factor for the development of postoperative brachial plexus injury. Recovery occurs in the majority of cases but may require weeks to months of therapy after initial presentation.

CONCLUSION

Brachial plexus injuries are an increasingly recognized complication following spinal surgery. Proper attention to patient positioning with the use of intraoperative electrophysiological monitoring techniques could minimize injury.