Surgery In Lithotomy Position Research Articles

Severe Tibial Neuropathy and Myonecrosis After Prolonged Surgery in Lithotomy Position (P13-8.008)

<h3>Objective:</h3> Explore risks and diagnosis of this unusual injury. <h3>Background:</h3> Peripheral neuropathies and myonecrosis are post-operative complications associated with prolonged surgeries in lithotomy position. Peroneal, sciatic, obturator, lateral femoral cutaneous, and femoral nerves are most affected but tibial neuropathy is not reported. <h3>Design/Methods:</h3> A 55-year-old man with rectal cancer underwent robotic surgery in lithotomy position for &gt;12 hours. Post-operatively, his left calf was swollen, with focal painful “knot”. CK was 4,661 improving to 547 within 5 days, consistent with rhabdomyolysis without compartment syndrome, given a compressible calf. His pain became neuropathic with burning in the sole, worse with weightbearing. <h3>Results:</h3> MRI 2 weeks later showed calf myonecrosis. Exam 1 month later revealed altered pinprick sensation with hyperesthesia in left sole, absent left ankle reflex, inability to walk on toes, intact strength. EMG showed severe left tibial nerve injury (nearly absent motor and sensory amplitudes but no denervation/reinnervation, suggestive of demyelinating process) and generalized polyneuropathy. Oxaliplatin was omitted from future chemotherapy plan, to avoid further neurotoxicity. <h3>Conclusions:</h3> This case underscores the importance of EMG in localization, characterizing injury (axonal or demyelinating), prognosis for recovery. The tibial neuropathy may improve due to the possibility of conduction block, rather than axonal injury; this correlates with intact strength on exam. EMG must be strategic; it is less sensitive in the acute period due to the time needed for Wallerian degeneration to be measurable on needle EMG. Despite careful padding and positioning, it is essential to recognize the risk, examine patients carefully, plan EMG for confirmation. The best risk mitigation is that of avoidance of prolonged surgery times. <b>Disclosure:</b> Dr. Ozel has nothing to disclose. Ms. Nash has nothing to disclose. Dr. Woodman has nothing to disclose.

The effect of different doses of chloroprocaine 1% for low dose saddle anaesthesia in outpatient perianal surgery: A prospective randomized study

The present study was designed to investigate saddle anesthesia with different doses of chloroprocaine at the same concentration (0.5%, w/v) in terms of extent of sensory and motor block, recovery from block, time for ambulation and time for urinary voiding. The study was conducted in the department of Anaesthesiology of a tertiary healthcare centre of southern Rajasthan. 120 patients of either sex, aged between 20-50 years, with American Society of Anaesthesiologists grade I/II scheduled for elective perianal surgery in lithotomy position (duration &amp;#60; 40 minutes), were enrolled in the study. The patients were divided into three groups (n=40/group), receiving either 10mg, 15mg or 20mg of 1% 2-chloroprocaine in saddle anaesthesia. The effect was noted and compared in terms of extent of sensory and motor block, recovery from block, time for ambulation and time for urinary voiding. All the three groups were comparable with no statistical difference in terms of age, weight, height, BMI, ASA grading and site of injection among the participants of the groups. Number of patients who were able to move from stretcher to operation table and again from operation table to stretcher without help did not differ significantly among all the three groups. Similarly, there was no statistically significant difference in pre operative and post operative Bromage scores of participants among three groups (p value &amp;#62; 0.05). There was significant difference in the number of anaesthetized dermatomes both pre and post operatively among all the three groups (p value &amp;#60;0.001). Duration of surgery did not differ significantly among the three groups. There was also significant diference in the time for unassisted ambulation post operatively and time for urinary voiding among the three groups (p value &amp;#60; 0.001). 10 mg chloroprocaine may cause early post operative pain while 30 mg dose may cause delayed unassisted ambulation and urinary voiding postoperatively so 15 mg dose can be used as minimum optimal dose for saddle anaesthesia for ultra-short perianal procedures.

Comparison of Combined Forced-Air Warming and Circulating-Water-Mattress and Forced-Air Warming Alone in Patients Undergoing Open Abdominal Surgery in Lithotomy Position: a Randomized Controlled Trial

The objective of this study was to evaluate the efficacy of warming devices in patients undergoing open abdominal surgery in lithotomy position. This randomized, controlled trial was designed to compare body temperatures of patients undergoing open abdominal surgery in lithotomy position between February and May 2019. After prewarming for 30 min with forced-air using a full-body blanket, patients were randomized to receive intraoperative warming either with forced-air using a blanket covering the upper torso and upper extremities in combination with circulating-water-mattress warming the back (Group I) or with only forced-air using blanket covering the upper torso and upper extremities (Group II). Primary outcome measure was the intraoperative change in core-body temperature using oesophageal temperature probe. A total of 28 patients were randomized. The mean core-body temperatures (Group I: 36.1 SD0.41 vs Group II: 35.9 SD0.53 °C; p=0.139) and intraoperative changes (Group I: 0.41% vs Group II: − 0.001%; p=0.306) were similar. The core-body temperature at the end of the operation correlated with the operating room temperature in Group II (r=0.862, p<0.001), but not in Group I (r=0.323, p=0.259). The combination of forced-air warming and circulating-water-mattress for open abdominal surgery in the lithotomy position may be more beneficial than forced-air warming alone, due to maintenance of the intraoperative mean core-body temperature ≥36°C, despite variations in operating room temperature. Trial Registry Number: ClinicalTrials.gov Identifier: NCT03824262 (Date of registry: 29 January 2019)

Hyperbaric oxygen therapy in peroneal nerve damage due to lithotomy position

Peripheral neuropathies can be seen in patients who are operated in lithotomy position. In this case report, patient which had right drop foot after urethroplasty surgery in lithotomy position was treated. Electromyography (EMG) was performed at postoperative 1st day and demonstrated right peroneal nerve palsy. Physiotherapy (knee extension, cycling, and passive dorsiflexion), vitamin B complex (B1, B6, folic acid and B12) and daily hyperbaric oxygen treatment were started. Fifth day after surgery, improvement of moving the right foot was detected clinically. Patient was discharged on 7th postoperative day and neurologist suggested to continue physiotherapy and vitamin B complex for 3 weeks. After this period, control EMG showed the development of peroneal nerve functions. The patient had a fully functional right foot with all these treatments one month after surgery. Effectivity of hyperbaric oxygen in treatment of peripheral nerve degeneration was seen in several studies in literature (4). In a few studies, the effect of hyperbaric oxygen on peroneal nerve palsy has not been demonstrated (5). The patient recovered earlier than other patients in literature. In this case, the treatment difference was hyperbaric oxygen treatment from other cases in literature. Before the start of lithotomy operations, patients should be carefully evaluated for peroneal nerve palsy risk factors and appropriately positioned to prevent iatrogenic peroneal nerve palsy in the operation. After operation, if peroneal nerve palsy develops, physiotherapy should start as soon as possible. Hyperbaric oxygen is kept in mind as supplemental treatment even if it is not in standard treatment protocol in peroneal nerve palsy.

Application of a moving folding multifunction operating platform in operation room

Objective To discuss the effect of a moving folding multifunction operating platform in operation room so as to solve time-consuming and efforts in the putting lithotomy position of repeating placement and removal surgery bed legs plate and supply the operating platform in the surgery of the upper limb, invasive puncture and anesthesia operation. Methods A moving folding multifunction operating platform was self-designed. A number of 160 cases undergoing operation in lithotomy position in the urology department from March to June 2016 were randomly divided into the experimental group (80 cases) and the control group (80 cases). The routine nursing method were carried out in patients in the control group, while adopted operating platform were used in patients in the experimental group. Time-consuming pre and post operation were investigated. Application effects of moving folding multifunction operating platform in 114 cases including the surgery of the upper limb, invasive puncture and anesthesia operation were evaluated. Results During continues lithotomy position surgery, time consuming of changing position and position placement in the experimental group were (209.41±33.36) s and (622.33±62.16) s respectively, while those in the control group were (665.83±90.92) s and (1 118.33±88.86) s. The differences were statistically significant between two groups (t=16.324, 15.844; P<0.05). In one lithotomy position surgery, time consuming of position placement pre and post operation were reduced 44.03% (saved 8.16 minutes/surgery) compared to that in the control group. It alleviated 60 kg body burden of nurses. The safety and performance evaluation in the surgery of the upper limb, invasive puncture and anesthesia operation were in high levels with scores of (26.13±1.53) and (27.42±1.56) respectively. Conclusions The platform, which is practical and easy to use, contributes to meet the needs of a variety of technical operation in the operation room and helps optimizing procedure in transformation, reducing work load of nurse so as to improve efficiency and quality of work. Key words: Innovation and promotion; Operating room nursing; Position; Multifunction operating platform

A case of compartment syndrome following robotic surgery in lithotomy position

Compartment syndrome, occurring rarely after prolonged surgery in the lithotomy position, is a clinical statement, which may result in catastrophic complications. Compartment syndrome, which is commonly seen after major pelvic surgery is reported most commonly after prolonged urological procedures with an estimated incidence of 1 in 500 cases. [1]. Compartment syndrome has similar clinical findings with deep venous thrombosis, which is common in clinical practice of cardiovascular surgeons. It is important to make differential diagnosis of compartment syndrome to avoid the complications that are preventable with early diagnosis. In our case, at first our diagnosis was deep venous thrombosis because of the malignity story, and similar clinical findings. However, as a result the compartment syndrome was the current diagnosis. We want to present a case of compartment syndrome , which must be keep in mind in the diagnosis of deep venous thrombosis, in the light of current literature.

Influence of nursing intervention on blood pressure change for patients with lithotomy position surgery

Objective To investigate the effect of medical elastic bandage and passive lower limb movement on blood pressure changes for patients with lithotomy surgery. Methods 300 cases of lithotomy surgery patients in our hospital were randomly divided into three groups with 100 cases in each group.Group A was taken with routine care as the control group.Group B was taken with the medical elastic bandage based upon routine care.Group C was given passive movement in the lower limb based upon routine care.The blood pressure changes for three groups of patients were compared. Results The lower extremities flat blood pressure was significantly reduced for patients of group A.The average arterial blood pressure decreased significantly at the flat lower limb immediately and after 5 min.The changes were statistically significant compared with patients of group B and C. Conclusions The medical elastic bandages and lower limb passive motion play a role in stabilizing the blood pressure of patients with lithotomy position surgery,which is worthy of clinical promotion. Key words: Medical elastic bandage; Lower limb passive motion; Lithotomy surgery; Changes in blood pressure; Influencing effect

Common Peroneal Nerve Palsy: An Unexpected Complication of Liver Surgery

Background Common peroneal nerve palsy is a well-recognized complication following surgery in lithotomy position, particularly colorectal and gynecologic surgery. But it is quite rare after liver surgery because patients are usually placed in supine position. Case report There were three cases of common peroneal nerve palsy after liver surgery in the past 2 years, including two cases of liver transplantation and one case of extended right hepatectomy. Two cases were bilateral and one case was unilateral. They were placed in supine position and the mean operative time was 8 hours. Patients complained symptom of foot drop within 1 week after operation. Electromyographic examinations showed evidence compatible with common peroneal nerve palsy. All of them improved with conservative treatment within 6 months. Conclusion Common peroneal nerve palsy may develop after liver surgery even in supine position. Injury to common peroneal nerve should be a concern before and during the operation. This complication could be managed conservatively with an uneventful result.

Common peroneal nerve palsy: An unexpected complication of liver surgery

Abstract Background Common peroneal nerve palsy is a well-recognized complication following surgery in lithotomy position, particularly colorectal and gynecologic surgery. But it is quite rare after liver surgery because patients are usually placed in supine position. Case report There were three cases of common peroneal nerve palsy after liver surgery in the past 2 years, including two cases of liver transplantation and one case of extended right hepatectomy. Two cases were bilateral and one case was unilateral. They were placed in supine position and the mean operative time was 8 hours. Patients complained symptom of foot drop within 1 week after operation. Electromyographic examinations showed evidence compatible with common peroneal nerve palsy. All of them improved with conservative treatment within 6 months. Conclusion Common peroneal nerve palsy may develop after liver surgery even in supine position. Injury to common peroneal nerve should be a concern before and during the operation. This complication could be managed conservatively with an uneventful result.

Aortic endograft thrombosis after colorectal surgery in lithotomy position

Aortic endograft limb occlusion is a serious complication after endovascular abdominal aortic aneurysm repair. We describe a yet unreported cause of endograft limb occlusion, the lithotomy position. Two patients with abdominal aortic aneurysm and colorectal cancer underwent an initial endovascular repair followed by cancer resection in the lithotomy position. Aortic endograft limb occlusion occurred in both patients immediately after the cancer operation. Percutaneous rheolytic thrombectomy was performed successfully in both patients. Pelvic surgery requiring the lithotomy position should be performed with caution in patients with aortic endografts, because it can result in endograft occlusion.

Acute compartment syndrome of the lower leg: retrospective study on prevalence, technique, and outcome of fasciotomies.

The acute compartment syndrome is caused by bleeding or edema in a closed muscle compartment surrounded by fascia and bone. It is characterized by increased intracompartmental pressure and decreased tissue perfusion. Well-known causative incidents are acute trauma and reperfusion after treatment for acute arterial obstruction. Most commonly the lower leg is involved. Inadequate therapy of the syndrome usually leads to muscle ischemia, rhabdomyolysis, and renal insufficiency. Perioperative morbidity and mortality are high. Although compartment syndromes can be caused by various factors, up until now no comparative studies have been published on clinical outcome of compartment syndromes of different origin. In this retrospective study we analyzed 40 successive cases of fasciotomy for acute lower leg compartment syndrome to study whether different causes of the syndrome lead to different clinical outcomes. We also studied other predictive factors for clinical outcome. The causes for the compartment syndromes were trauma, vascular deobstruction, cardiac surgery, and gastrointestinal surgery in lithotomy position. Clinical outcome showed a mortality of 15% and serious overall morbidity. Multivariate analysis showed the only significant predictive determinant of outcome to be the age of the patient. Fasciotomy for acute compartment syndrome is associated with serious morbidity and mortality. No correlation between causative factors and clinical outcome could be found.