Rise in Robotic Surgeries May Lead to More Nerve Injuries

The number of laparoscopic and robotic surgeries has increased dramatically over the past few decades. While these surgeries offer benefits such as smaller incisions and decreased blood loss, they are not without risk. The procedures often require steeper Trendelenburg positioning and longer operating times, which can lead to brachial plexus and other nerve injuries

Normally, the brachial plexus is protected from injury by the surrounding bones in the shoulder. However, Trendelenburg positioning during surgery can leave the area vulnerable. Although relatively uncommon, with an incidence of 0.16%, the risk of surgical-related brachial plexus injury should not be downplayed. These patient injuries have been shown to cause significant postoperative morbidity and can have serious legal implications. In some parts of the world, a disproportionately large number of malpractice claims against obstetricians derive from such injuries.

Position to Protect

Fortunately, the incidence of brachial plexus injuries may be reduced through careful attention to patient positioning. In fact, the majority of these types of injuries can be directly attributed to improper or inadequate patient positioning.

According to the Association of Surgical Technologies (AST), proper positioning should start with a comprehensive patient assessment. The assessment should include age, weight, height, skin integrity, range of motion and pre-existing conditions. The AST, as well as several clinical studies, also stresses the importance of patient positioning devices. Recommendations include using a patient positioner that does not require shoulder braces, but does incorporate ample gel-based padding to redistribute pressure and minimize slipping. In addition, protective padding on the arm board and limiting arm abduction to 90 degrees have been highlighted in other studies as valuable protective features.

The risk of brachial plexus injury during surgery may be small, but the consequences may not be. An easy-to-use Trendelenburg positioner that reduces focal pressure and minimizes slipping may be the key to making that risk even lower.