Objective: To investigate whether ankle braces or shoulder support used for fixation during robot-assisted radical prostatectomy (RARP), where patients are commonly positioned in the head-down Trendelenburg position, differ in their potential to cause peripheral nerve injury.
Patients and methods: A prospective, double-blind, randomised controlled trial was conducted on patients undergoing RARP for prostate cancer between May 2020 and September 2021 using the da Vinci® Si system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Patients were randomly assigned to either the shoulder or ankle brace fixation group and were positioned in a modified lithotomy position. Neurological examinations were performed pre- and postoperatively. The primary endpoint was the prevalence of any peripheral neuropathy on the first postoperative day.
Results: A total of 98 patients were treated using the da Vinci Si system: 46 in the lithotomy lower fixation group and 52 in the lithotomy upper fixation group. Both groups mainly recorded neuropathies in the lower extremity, with a total incidence of 6.9% for lower neuropathies and 3.9% for upper neuropathies. All neuropathies were sensory, with one exception in the upper fixation group presenting a motor deficit. Over a median follow-up of 12 months, no neuropathies persisted. Neuropathy on the first postoperative day was observed in 15% of patients in the upper fixation group and 6.5% in the lower fixation group (P = 0.2).
Conclusion: We observed neuropathies in a clinically relevant proportion of men undergoing RARP. We were not able to demonstrate a significant difference regarding postoperative neuropathies between ankle braces or shoulder support during RARP.
Keywords: lithotomy position; neuropathy peripheral; postoperative complications; prostatectomy; robotic surgical procedure.
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