Factors Associated With Peripheral Nerve Injury After Pelvic Laparoscopy: The Importance of Surgical Positioning

10.1097/jnr.0000000000000530

Ainhoa ZARANDONA DEL CAMPO；Nerea HERREROS MARIAS；Alazne TORVISCO MACIAS；Ana Mar í a BARANDICA BILBAO；Lorea RODRIGUEZ OTAZUA；Urko AGUIRRE LARRACOECHEA；Ane VILLANUEVA ETXEBARRIA；Vicente PORTUGAL PORRAS

peripheral nerve injury ； patient positioning ； laparoscopy ； nerve injury ； Trendelenburg

The Journal of Nursing Research

31卷1期（2023 / 02 / 01）

1 - 7

英文

Background: Nerve damage after abdominal and pelvic surgery is rare but potentially serious. The incidence of peripheral nerve injury is difficult to assess, and rates of between 0.02% and 21% have been cited in the literature. Signs and symptoms of this type of injury may appear immediately after surgery or a few days later. Purpose: This study was developed to assess the rate of peripheral nerve injury after pelvic laparoscopy and to identify associated risk factors. Methods: A pilot prospective cohort study was conducted between March 2018 and April 2019 on 101 patients with a 1-month follow-up using two semistructured clinical interviews. We carried out a descriptive analysis followed by univariable and multivariable logistic regression analyses. Results: Thirteen patients were found to have peripheral nerve injuries, representing a rate of 12.9%. Overall, 14 injuries (five severe and nine mild) were detected. One patient had two mild injuries. In this study, the risk of injury was found to increase 1.77-fold (OR = 1.77, 95% CI [1.13, 2.76], p = .007) for each hour the patient was in the Trendelenburg position. Conclusions/Implications for Practice: The longer the patient is in the Trendelenburg position, the greater the risk of peripheral nerve damage. Patients aged 60 years or less also face a higher risk of nerve injury.

1. Abdalmageed, O. S.,Bedaiwy, M. A.,Falcone, T.(2017).Nerve injuries in gynecologic laparoscopy.Journal of Minimally Invasive Gynecology,24(1),16-27.
2. Agostini, J.,Goasguen, N.,Mosnier, H.(2010).Patient positioning in laparoscopic surgery: Tricks and tips.Journal of Visceral Surgery,147(4),227-232.
3. Akhavan, A.,Gainsburg, D. M.,Stock, J. A.(2010).Complications associated with patient positioning in urologic surgery.Urology,76(6),1309-1316.
4. Al-Temimi, M. H.,Chandrasekaran, B.,Phelan, M. J.,Pigazzi, A.,Mills, S. D.,Stamos, M. J.,Carmichael, J. C.(2017).Incidence, risk factors, and trends of motor peripheral nerve injury after colorectal surgery: Analysis of the national surgical quality improvement program database.Diseases of the Colon & Rectum,60(3),318-325.
5. Bjøro, B.,Mykkeltveit, I.,Rustøen, T.,Altinbas, B. C.,Røise, O.,Bentsen, S. B.(2019).Intraoperative peripheral nerve injury related to lithotomy positioning with steep Trendelenburg in patients undergoing robotic-assisted laparoscopic surgery.Journal of Advanced Nursing,76(2),490-503.
6. Bohrer, J. C.,Walters, M. D.,Park, A.,Polston, D.,Barber, M. D.(2009).Pelvic nerve injury following gynecologic surgery: A prospective cohort study.American Journal of Obstetrics and Gynecology,201(5),537.e1-537.e7.
7. Bouyer-Ferullo, S.(2012).Preventing perioperative peripheral nerve injuries.AORN Journal,97(1),110-124.
8. Bouyer-Ferullo, S.,Androwich, I. M.,Dykes, P. C.(2015).Clinical decision support and perioperative peripheral nerve injury: A quality improvement project.Computers, Informatics, Nursing,33(6),238-248.
9. Codd, R. J.,Evans, M. D.,Sagart, P. M.,Williams, G. L.(2013).A systematic review of peripheral nerve injury following laparoscopic colorectal surgery.Colorectal Disease,15(3),278-282.
10. Colsa Gutiérrez, P.,Viadero Cervera, R.,Morales-García, D.,Ingelmo Setién, A.(2016).Intraoperative peripheral nerve injury in colorectal surgery. An update.Cirugia Espanola,94(3),125-136.
11. Das, D.,Propst, K.,Wechter, M. E.,Kho, R. M.(2019).Evaluation of positioning devices for optimization of outcomes in laparoscopic and robotic-assisted gynecologic surgery.Journal of Minimally Invasive Gynecology,26(2),244-252.
12. Ellebrecht, D. B.,Wolken, H.,Ellebrecht, C. T.,Bruch, H. P.,Kleemann, M.(2015).Positioning injuries to peripheral nerves during laparoscopic colon and rectum surgery.Zentralblatt fur Chirurgie,140(6),610-616.
13. Elsevier (Ed.)(2016).Youmans and Winn neurological surgery.Elsevier.
14. Güzelküçük, Ü.,Skempes, D.,Kumnerddee, W.(2014).Common peroneal nerve palsy caused by compression stockings after surgery.American Journal of Physical Medicine & Rehabilitation,93(7),609-611.
15. Harada, Y.,Tanaka, J.,Umemoto, T.,Sekine, R.,Wakabayashi, T.,Kijima, K.,Kigawa, G.(2019).Toward standardized patient positioning to avoid peripheral nerve injury during laparoscopic colorectal surgery: Application of a protocol and study of the resulting relationship between total rotation time and contact pressure at the shoulder.Asian Journal of Endoscopic Surgery,12(3),269-274.
16. Kim, J. H.,Kim, W. I.,Kim, J. Y.,Choe, W. J.(2016).Peroneal nerve palsy after compression stockings application.Saudi Journal of Anaesthesia,10(4),462-464.
17. Klauschie, J.,Wechter, M. E.,Jacob, K.,Zanagnolo, V.,Montero, R.,Magrina, J.,Kho, R.(2010).Use of anti-skid material and patient-positioning to prevent patient shifting during robotic-assisted gynecologic procedures.Journal of Minimally Invasive Gynecology,17(4),504-507.
18. Kumar, A.,Shukla, D.,Bhat, D. I.,Devi, B. I.(2019).Iatrogenic peripheral nerve injuries.Neurology India,67(7),135-139.
19. Navarro-Vicente, F.,García-Granero, A.,Frasson, M.,Blanco, F.,Flor-Lorente, B.,García-Botello, S.,García-Granero, E.(2011).Prospective evaluation of intraoperative peripheral nerve injury in colorectal surgery.Colorectal Disease,14(3),382-385.
20. Treszezamsky, A. D.,Fenske, S.,Moshier, E. L.,Ascher-Walsh, C. J.(2017).Neurologic injury and patient displacement in gynecologic laparoscopic surgery using a beanbag and shoulder supports.International Journal of Gynecology & Obstetrics,140(1),26-30.
21. Wallis, C. J. D.,Peltz, S.,Byrne, J.,Kroft, J.,Karanicolas, P.,Coburn, N.,Nathens, A. B.,Nam, R. K.,Hallet, J.,Satkunasivam, R.(2017).Peripheral nerve injury during abdominal-pelvic surgery: Analysis of the national surgical quality improvement program database.The American Surgeon,83(11),1214-1219.
22. Welch, M. B. (2017). Patient positioning for surgery and anesthesia in adults. https://www.uptodate.com/contents/patient-positioning-for-surgery-and-anesthesia-in-adults?source=history_widget