Intraoperative peripheral nerve injury related to lithotomy positioning with steep Trendelenburg in patients undergoing robotic‐assisted laparoscopic surgery – A systematic review

Autor: Bahar Candaş Altinbaş, Tone Rustøen, Benedikte Bjøro, Ida Mykkeltveit, Olav Røise, Signe Berit Bentsen
Rok vydání: 2019
Předmět:
Zdroj: Journal of Advanced Nursing. 76:490-503
ISSN: 1365-2648
0309-2402
DOI: 10.1111/jan.14271
Popis: To examine the incidence of intraoperative peripheral nerve injury, symptoms, risk factors, functions, and quality of life in patients undergoing robotic-assisted laparoscopic surgery to lithotomy positioning with steep Trendelenburg.A systematic review.The Cochrane Library catalogue, PubMed, EMBASE, CINHAL and SveMed + databases were searched from January 2000 - February 2019.Titles and abstracts were screened for inclusion. Full-text assessments of each paper were conducted by two reviewers. The quality of the included papers was assessed using the Mixed Methods Appraisal Tool. Descriptive statistics and thematic analysis were used to synthesize the data.Eleven quantitative studies were included with three themes: (a) incidence of intraoperative peripheral nerve injury; (b) upper extremity intraoperative peripheral nerve injury related to steep Trendelenburg positioning; and (c) lower extremity intraoperative peripheral nerve injury related to lithotomy positioning. The overall incidence of intraoperative peripheral nerve injury in robotic-assisted laparoscopic urologic, gynaecologic and colorectal surgery was 0.16%-10.0% and the symptoms appeared immediately after surgical procedures. Risk factors for intraoperative peripheral injury were prolonged operative time, high American Society of Anesthesiologists scores, comorbidities and high body mass index.Intraoperative peripheral nerve injuries are rare, but occasionally serious when related to lithotomy positioning with steep Trendelenburg. Operating room nurses have a responsibility both for positioning patients and for being familiar with the technological developments that will influence the preoperative handling of patients.This systematic review emphasizes the need for operating room nurses together with surgical team to have knowledge about mechanisms for injury, positioning, anatomy/physiology, and evaluation of risk factors to ensure that patients are not exposed for intraoperative peripheral nerve injuries. Increased robotic-assisted laparoscopic surgery necessitates further research examining the incidence of intraoperative peripheral nerve injury related to positioning and how these affect patients' function and the quality of life.目的: 研究术中外周神经损伤的发生率,机器人辅助腹腔镜手术和特伦德伦伯格卧位取石定位患者的症状、危险因素、功能及生活质量。 设计: 系统评估。 数据来源: 通过Cochrane图书馆目录、PubMed、EMBASE、CINHAL和SveMed+数据库进行检索(从2000年1月至2019年2月)。 评估方法: 对文献标题和摘要进行筛选,查看是否符合纳入标准。由两名评估人员对每篇论文的全文内容进行评价。采用混合法评价工具对纳入的论文质量进行评估。采用描述性统计和专题分析来综合数据。 结果: 共纳入11项定量研究,包括三个主题:(a)术中外周神经损伤的发生率;(b)上肢术中外周神经损伤与特伦德伦伯格卧位定位的关系;以及(c)下肢术中外周神经损伤与取石定位的关系。机器人辅助腹腔镜泌尿外科、妇科、结直肠外科术中外周神经损伤的总体发生率为0.16%-10.0%,术后立即出现症状。术中外周损伤的危险因素包括手术时间过长、美国麻醉医师协会评分过高、出现合并症和体重指数过高。 结论: 发生术中外周神经损伤的情况极少,但在实施特伦德伦伯格卧位取石定位时偶发严重。手术室护士不仅需负责患者的手术定位操作,还须熟悉影响患者术前处理的技术发展动态。 影响: 本项系统评估强调,手术室护士和手术团队需了解损伤机制、定位操作、解剖/生理学和危险因素评估,以便确保患者不会出现术中外周神经损伤的情况。随着机器人辅助腹腔镜手术的广泛应用,有必要对与定位相关的术中外周神经损伤的发生率,以及这些损伤将对患者的功能和生活质量产生何种影响开展进一步研究。.
Databáze: OpenAIRE
Externí odkaz: