Abstract
BackgroundThe indications for robot-assisted urologic surgeries have expanded due to their low invasiveness. However, complicated surgical procedures lead to prolonged surgical duration, requiring patients to remain in the lithotomy position for an extended time. Well leg compartment syndrome (WLCS) is a known severe postoperative complication related to the lithotomy position.Case presentationWe report a case of WLCS after robot-assisted radical cystectomy (RARC), in which the patient recovered without neurological sequelae. A 55-year-old, obese male who underwent RARC complained of right leg pain and paresthesia 3 h after the surgery that lasted for 481 min. Emergency evaluation revealed unilateral WLCS in the anterior and lateral compartments. Urgent fasciotomy was performed 4 h after symptom onset. He thereafter recovered completely and was discharged without any neuromuscular dysfunction.ConclusionsEarly detection of WLCS, surgical treatment, and additional measures are crucial to prevent its life-threatening and/or disabling outcomes.
Highlights
The indications for robot-assisted urologic surgeries have expanded due to their low invasiveness
Well leg compartment syndrome (WLCS) is defined as compartment syndrome caused by the intraoperative lithotomy position [1, 2]
We report a rare case of unilateral WLCS following robot-assisted radical cystectomy (RARC)
Summary
Compartment syndrome is a severe morbidity that can lead acutely to rhabdomyolysis and renal failure and chronically to neurogenic paralysis and permanent disability [1, 2]. Compartment pressures of the right calf measured under general anesthesia with a needle manometer (TraWave®, Edwards Lifesciences, Irvine, CA, USA) were high at 38, 19, and 14 mmHg in the anterior, lateral, and posterior compartments, respectively. Fasciotomies performed on both sides of the calf reduced compartment pressures to 18, 14, and 12 mmHg, respectively (Fig. 1b). Subsequent hematological examinations indicated a return of CK to a normal level (218 U/l) by postoperative day 15 After the fasciotomy, he required debridement procedures twice due to local infection, followed by a skin graft to compensate for the skin defect 43 days after RARC. He was discharged from hospital 78 days after RARC without any neuromuscular disorders and in an ambulatory condition
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