Ulm Michael A, Fleming Nicole D, Rallapali Vijayashri, Munsell Mark F, Ramirez Pedro T, Westin Shannon N, Nick Alpa M, Schmeler Kathleen M, Soliman Pamela T
Department of Obstetrics and Gynecology, University of Tennessee, Memphis, TN, USA.
Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Gynecol Oncol. 2014 Dec;135(3):534-8. doi: 10.1016/j.ygyno.2014.10.016. Epub 2014 Oct 23.
To assess the rate and risk factors for position-related injury in robotic gynecologic surgery.
A prospective database from 12/2006 to 1/2014 of all planned robotic gynecologic procedures was retrospectively reviewed for patients who experienced neurologic injury, musculoskeletal injury, or vascular compromise related to patient positioning in the operating room. Analysis was performed to determine risk-factors and incidence for position-related injury.
Of the 831 patients who underwent robotic surgery during the study time period, only 7 (0.8%) experienced positioning-related injury. The injuries included minor head contusions (n=3), two lower extremity neuropathies (n=2), brachial plexus injury (n=1) and one large subcutaneous ecchymosis on the left flank and thigh (n=1). There were no long term sequelae from the positioning-related injuries. The only statistically significant risk factor for positioning-related injury was prior abdominal surgery (P=0.05). There were no significant associations between position-related injuries and operative time (P=0.232), body mass index (P=0.847), age (P=0.152), smoking history (P=0.161), or medical comorbidities (P=0.229-0.999).
The incidence of position-related injury among women undergoing robotic surgery was extremely low (0.8%). Due to the low incidence we were unable to identify modifiable risk factors for position-related injury following robotic surgery. A standardized, team-oriented approach may significantly decrease position-related injuries following robotic gynecologic surgery.
评估机器人妇科手术中与体位相关损伤的发生率及危险因素。
回顾性分析2006年12月至2014年1月所有计划进行的机器人妇科手术的前瞻性数据库，以确定在手术室中因患者体位导致神经损伤、肌肉骨骼损伤或血管受压的患者。进行分析以确定与体位相关损伤的危险因素和发生率。
在研究期间接受机器人手术的831例患者中，只有7例（0.8%）发生了与体位相关的损伤。损伤包括轻度头部挫伤（n = 3）、两例下肢神经病变（n = 2）、臂丛神经损伤（n = 1）和一例左侧胁腹及大腿大面积皮下瘀斑（n = 1）。与体位相关的损伤没有长期后遗症。与体位相关损伤的唯一具有统计学意义的危险因素是既往腹部手术（P = 0.05）。与体位相关的损伤与手术时间（P = 0.232）、体重指数（P = 0.847）、年龄（P = 0.152）、吸烟史（P = 0.161）或合并症（P = 0.229 - 0.999）之间无显著关联。
接受机器人手术的女性中与体位相关损伤的发生率极低（0.8%）。由于发生率低，我们无法确定机器人手术后与体位相关损伤的可改变危险因素。一种标准化的、以团队为导向的方法可能会显著降低机器人妇科手术后与体位相关的损伤。
