Göksu Şenay, Karaören Gülşah, Tahra Ahmet, İnkaya Abdurrahman, Küçük Eyüp Veli, Bakan Nurten
Anaesthesiology and Reanimation Department, Health Science University, Umraniye Training and Research Hospital, Istanbul, Turkey. (Drs. Göksu and Bakan).
Anaesthesiology and Reanimation Department, Das Alice-Hospital Darmstadt, Darmstadt, Germany. (Dr. Karaören).
JSLS. 2025 Jul-Sep;29(3). doi: 10.4293/JSLS.2025.00031. Epub 2025 Aug 7.
One of the responsibilities of the anesthesiologist is to maintain the physiologic anatomic position during surgery. Postoperative positional peripheral nerve injury (PPPNI) inevitably may occur during robot-assisted laparoscopic radical prostatectomy (RARP) in steep-Trendelenburg-lithotomy positioning. The primary aim of the study was to identify incidence and risk factors for the development of PPPNI in the RARP and the secondary aim was to identify the most common types and duration of PPPNI.
After ethics committee and patients approval, patients who underwent RARP in past 7 years were retrospectively evaluated. Patients with known peripheral neuropathy were excluded. Patient demographics, American Society of Anesthesiologists (ASA) score, body mass index (BMI), Charlson comorbidity index (CCI), operative time (OT), and Trendelenburg time (TT) were obtained from the records. Patients were asked if they had PPPNI and other descriptive questions.
A total of 868 patients were included in the study. The mean age, BMI, ASA risk score, and CCI were 63.44 ± 6.68 years, 27.46 ± 2.75 kg/m, 1.76 ± 0.62, and 2.41 ± 0.89, respectively. PPPNI rate was 5.6% (49 patients). The mean OT, TT and recovery time were 168.83 ± 52.1 minutes, 110.74 ± 46.33 minutes, and 6.5 ± 2.81 months, respectively. The BMI, OT, and TT values of patients with PPPNI were significantly higher than those of patients without PPPNI ( < .01). The cutoff values were 29, 212, and 157 minutes, respectively. Of the 49 patients with PPPNI, 55.1% had upper extremity injuries (pain 51.9%), 51% had lower extremity injuries (motor deficit 58.3%), and 6.1% had injuries to both. Six patients claimed PPPNI.
The RARP is associated with an elevated risk of PPPNIs, particularly in cases of prolonged OT, TT, and high BMI.
麻醉医生的职责之一是在手术过程中维持生理解剖位置。在机器人辅助腹腔镜根治性前列腺切除术（RARP）中采用极度头低脚高位膀胱截石位时，不可避免地可能会发生术后体位性周围神经损伤（PPPNI）。本研究的主要目的是确定RARP中PPPNI的发生率及危险因素，次要目的是确定PPPNI最常见的类型和持续时间。
经伦理委员会和患者批准后，对过去7年接受RARP手术的患者进行回顾性评估。排除已知患有周围神经病变的患者。从病历中获取患者的人口统计学资料、美国麻醉医师协会（ASA）评分、体重指数（BMI）、查尔森合并症指数（CCI）、手术时间（OT）和头低脚高位时间（TT）。询问患者是否有PPPNI以及其他描述性问题。
本研究共纳入868例患者。平均年龄、BMI、ASA风险评分和CCI分别为63.44±6.68岁、27.46±2.75kg/m、1.76±0.62和2.41±0.89。PPPNI发生率为5.6%（49例患者）。平均OT、TT和恢复时间分别为168.83±52.1分钟、110.74±46.33分钟和6.5±2.81个月。发生PPPNI的患者的BMI、OT和TT值显著高于未发生PPPNI的患者（P<0.01）。临界值分别为29、212和157分钟。在49例PPPNI患者中，55.1%有上肢损伤（疼痛占51.9%），51%有下肢损伤（运动功能障碍占58.3%），6.1%上下肢均有损伤。6例患者声称有PPPNI。
RARP与PPPNI的风险升高相关，尤其是在OT、TT延长和BMI较高的情况下。
