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机器人辅助腹腔镜手术患者术中外周神经损伤与特伦德伦伯格卧位取石定位的关系——系统评估
Author(s) -
Bjøro Benedikte,
Mykkeltveit Ida,
Rustøen Tone,
Candas Altinbas Bahar,
Røise Olav,
Bentsen Signe Berit
Publication year - 2020
Publication title -
journal of advanced nursing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.948
H-Index - 155
eISSN - 1365-2648
pISSN - 0309-2402
DOI - 10.1111/jan.14271
Subject(s) - lithotomy position , medicine , peripheral nerve injury , trendelenburg position , trendelenburg , cochrane library , laparoscopic surgery , laparoscopy , surgery , peripheral nerve , randomized controlled trial , alternative medicine , pathology , anatomy
Aims 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. Design A systematic review. Data sources The Cochrane Library catalogue, PubMed, EMBASE, CINHAL and SveMed + databases were searched from January 2000 ‐ February 2019. Review methods 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. Results 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. Conclusion 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. Impact 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.