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.

Abstract

Generally, laparoscopic colorectal surgery is performed with the patient in the lithotomy and rotated positions. The lithotomy position, however, is associated with intraoperative peripheral nerve injury (IPNI). We studied the relationship between patient positioning during laparoscopic colorectal surgery, contact pressure at the shoulder, and the occurrence of IPNI and tested a positioning protocol aimed at surgical safety in addition to maintenance of a good surgical field. We applied our positioning protocol in 44 cases and collected data that could be used to answer our study questions. We set limits for shoulder contact pressure and time in the rotation position. When the time limit was reached, we returned the patient to the supine position for 5 min. Patients' median age was 71 years; mean BMI was 22.4 kg/m2 . Median time in the rotation position was 126 min. For the 22 patients for whom validated data was obtained, mean lower shoulder pressure changed from 8.5 mmHg just after rotation to 11.4 mmHg 120 min after rotation (P = 0.013). Absence of IPNI in our patients confirmed the proposed relation between patient positioning and IPNI. Our data indicate that a prolonged period in the rotation position increases contact pressure at the shoulder, which can increase the risk of IPNI. Our patient positioning protocol appears to have prevented laparoscopic colectomy-related IPNI. Future studies are warranted to confirm the relationship between patient positioning and IPNI and, if necessary, to further refine the protocol to ensure prevention of IPNI during laparoscopic colorectal surgery.