Brachial plexopathy in laparoscopic-assisted rectal surgery: a case series
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ORIGINAL ARTICLE
Brachial plexopathy in laparoscopic-assisted rectal surgery: a case series J. Eteuati • R. Hiscock • I. Hastie • I. Hayes I. Jones
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Received: 26 June 2012 / Accepted: 8 October 2012 / Published online: 28 November 2012 Ó Springer-Verlag Italia 2012
Abstract Background Brachial plexopathy may be caused by malpositioning during surgery when the body’s protective mechanism is lost under general anaesthesia. It is the second commonest nerve injury reported in the anaesthetized patient. The exact incidence in colorectal surgery is unclear but there have been numerous cases reported of brachial plexopathy as an adverse event following colorectal surgery. Although it is widely believed that these injuries are preventable by paying special attention to vulnerable areas during patient positioning and by careful intraoperative monitoring, it appears that nerve injury may still occur. Methods Patients with post-operative brachial plexopathy in our prospectively kept database were identified. The patient notes were reviewed and documented. Results In our series, five cases of brachial plexopathy were still observed despite careful precautions taken to prevent nerve injury. The proposed mechanism of nerve injury in our series is most likely due to nerve stretch. All symptoms resolved with the longest taking 7 months before resolution. During this period from 2005 to 2010 our unit performed 548 laparoscopic colorectal resections. The relative incidence of brachial plexopathy in our series is approximately 1 %.
J. Eteuati (&) I. Hastie I. Hayes I. Jones Colorectal Unit, Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia e-mail: [email protected] I. Jones e-mail: [email protected] R. Hiscock Melbourne Private Hospital, Parkville, VIC, Australia
Conclusion We recommend certain precautionary steps to follow, as well as predisposing and perioperative factors to be aware of when anticipating a laparoscopic colorectal procedure. These may all contribute to minimising brachial plexopathy which most likely is under-reported in laparoscopic colorectal surgery but is a preventable morbidity to the patient. Keywords Brachial plexopathy Laparoscopic colectomy Trendelenburg position Colorectal complications
Introduction Injury to the brachial plexus causes weakness, sensory loss and loss of tendon reflexes in the distribution of the nerve roots C5–T1. Brachial plexopathy (BP) may be caused by malpositioning during surgery when the body’s protective mechanism is lost under general anaesthesia. It is the second most common nerve injury reported in the anaesthetized patient [1, 2]. Romanowski et al. [3] reported an estimated incidence of 0.16 % in laparoscopic and robotic gynaecologic surgery. The exact incidence in colorectal surgery is unclear but there have been numerous cases reported of brachial plexopathy as an adverse event following colorectal surgery. Brill and Walfisch [4] in their series reported three cases of brachial plexopathy at the 12-month follow-up of 45 rectal
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