Brachial plexus injury after laparoscopic and robotic surgery.

The objective of this article was to review the literature regarding brachial plexus injury (BPI) in laparoscopic and robotic surgery. BPI complicates gynecologic laparoscopic surgery with an estimated incidence of 0.16%. Nevertheless, as the numbers of advanced laparoscopic and robotic procedures increase, the anticipated risk of this complication may rise as well. Robotic surgery often requires steeper Trendelenburg positioning and longer operative times when compared with traditional laparoscopic surgery. In this article we review the anatomy, pathophysiology, diagnosis, and treatment of position-related BPI in the context of laparoscopic and robotic gynecologic surgery. We suggest a multidisciplinary approach to the diagnosis and treatment of BPI. Recommendations for prevention of this complication are also provided.