The incidence of peripheral nerve injuries related to patient positioning during roboticassisted surgery: An evidence summary

Abstract

Objective: To describe the incidence and anatomical locations of peripheral nerve injuries (PNIs) related to patient positioning during urologic, gynaecologic and colorectal robotic-assisted surgery (RAS). Background: Incorrect positioning of extremities and lack of assistive devices in steep Trendelenburg (up to 45°) positioning during urologic, gynaecologic and colorectal RAS places the patient at potential risk of nerve injury. Method: A structured search of recent systematic reviews published between January 2019 and August 2021 in the Cochrane Library, PubMed, ProQuest and Google Scholar databases using search terms ‘patient positioning’, ‘roboticassisted surgery’, ‘Trendelenburg’, ‘complication’ and ‘injury’ with medical subject headings (MeSH) was conducted. Results: The overall incidence rates of PNI associated with patient positioning during RAS varied from 0.16 to 10.8 per cent. The most common anatomical positions of nerve injuries in upper extremities related to patient positioning during RAS were identified in brachial plexus, ulnar, median, radial and humeral nerves. For lower extremities, nerve injuries were identified in the sciatic, femoral, obturator, femoral cutaneous and common cutaneous nerves. Conclusion: Operating room teams should develop institutional policies to support perioperative practice that is based on the best available evidence. Application: This evidence summary supports the need for frequent routine checks and constant monitoring of the patient’s position through the operating procedure.