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Placing patients in the Trendelenburg position is wrought with potential complica-
tions. Patients might slide toward the head of the bed, resulting in skin burns
along the back, nerve damage near the shoulders and, during robotic surgery,
internal injuries caused by the static arms of the robot.
Injuries to the brachial plexus are common perioperative neuropathy, and are
more likely to occur in patients placed in steep 40-degree Trendelenburg during
robot-assisted procedures performed on the uterus, prostate or bladder. Avoiding
the use of shoulder braces limits the injury risk, although Advances in Anesthesia
(osmag.net/RPgJz4) researchers say mattresses and pads designed to prevent
patients from slipping aren't adequate solutions. They suggest the use of padded
shoulder braces and a headrest designed to distribute the body's weight evenly
across the shoulders and the base of the neck. They also say you should select prop-
erly fitted and well-padded leg positioners to avoid injuries caused by low perfusion
pressure that results from the legs remaining above the heart for long stretches dur-
ing surgery.
Research published in the AORN Journal (osmag.net/HHa7pN) has a different
take on protecting patients during robotic-assisted laparoscopic prostatectomy,
which requires patients to be placed in the low-lithotomy position with stirrups to
maneuver them properly under the robot and in steep Trendelenburg with arms at
their side for most of the procedure to shift the bowel toward the head. "This type of
extreme positioning may make it difficult to implement necessary safety measures,"
they write.
The study says an injury to the brachial plexus occurs in 0.16% of robotic or laparo-
scopic gynecologic surgery, which requires similar patient positioning. Although a
brachial plexus injury is relatively uncommon, it has several negative consequences,
ranging from numbness, weakness or loss of sensation or motor control of the arm
or hand, to severe pain.
Patients need to be properly supported on the table, but keeping them secure
with shoulder braces is "not recommended," according to the authors of the AORN
INJURY PREVENTION
The Trouble With Trendelenburg
