BJU international · 2024
Impact of patient positioning during surgery on neuropathies after robot-assisted laparoscopic radical prostatectomy: a randomised controlled trial.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Grossmann Nico Christian, Aschwanden Fabian Joel, Cornelius Julian, Malkmus Christian, Zahiti Leutrim, Viktorin Pascal, Fierley Lea, Wilder-Smith Einar, Baumeister Philipp, Mattei Agostino, Fankhauser Christian Daniel
Аннотация
OBJECTIVE: To investigate whether ankle braces or shoulder support used for fixation during robot-assisted radical prostatectomy (RARP), where patients are commonly positioned in the head-down Trendelenburg position, differ in their potential to cause peripheral nerve injury.
PATIENTS AND METHODS: A prospective, double-blind, randomised controlled trial was conducted on patients undergoing RARP for prostate cancer between May 2020 and September 2021 using the da Vinci® Si system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Patients were randomly assigned to either the shoulder or ankle brace fixation group and were positioned in a modified lithotomy position. Neurological examinations were performed pre- and postoperatively. The primary endpoint was the prevalence of any peripheral neuropathy on the first postoperative day.
RESULTS: A total of 98 patients were treated using the da Vinci Si system: 46 in the lithotomy lower fixation group and 52 in the lithotomy upper fixation group. Both groups mainly recorded neuropathies in the lower extremity, with a total incidence of 6.9% for lower neuropathies and 3.9% for upper neuropathies. All neuropathies were sensory, with one exception in the upper fixation group presenting a motor deficit. Over a median follow-up of 12 months, no neuropathies persisted. Neuropathy on the first postoperative day was observed in 15% of patients in the upper fixation group and 6.5% in the lower fixation group (P = 0.2).
CONCLUSION: We observed neuropathies in a clinically relevant proportion of men undergoing RARP. We were not able to demonstrate a significant difference regarding postoperative neuropathies between ankle braces or shoulder support during RARP.
PATIENTS AND METHODS: A prospective, double-blind, randomised controlled trial was conducted on patients undergoing RARP for prostate cancer between May 2020 and September 2021 using the da Vinci® Si system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Patients were randomly assigned to either the shoulder or ankle brace fixation group and were positioned in a modified lithotomy position. Neurological examinations were performed pre- and postoperatively. The primary endpoint was the prevalence of any peripheral neuropathy on the first postoperative day.
RESULTS: A total of 98 patients were treated using the da Vinci Si system: 46 in the lithotomy lower fixation group and 52 in the lithotomy upper fixation group. Both groups mainly recorded neuropathies in the lower extremity, with a total incidence of 6.9% for lower neuropathies and 3.9% for upper neuropathies. All neuropathies were sensory, with one exception in the upper fixation group presenting a motor deficit. Over a median follow-up of 12 months, no neuropathies persisted. Neuropathy on the first postoperative day was observed in 15% of patients in the upper fixation group and 6.5% in the lower fixation group (P = 0.2).
CONCLUSION: We observed neuropathies in a clinically relevant proportion of men undergoing RARP. We were not able to demonstrate a significant difference regarding postoperative neuropathies between ankle braces or shoulder support during RARP.