title: Survey of neuromuscular injuries to the patient and surgeon during urologic laparoscopic surgery.
abstract: OBJECTIVE
  Laparoscopy may be complicated by neuromuscular injuries, both to the patient and to the surgeon. We used a survey to estimate the incidence of these injuries during urologic laparoscopic surgery, to assess risk factors for these injuries, and to determine preventive measures.
  
  
  METHODS
  A survey of neuromuscular injuries associated with laparoscopy submitted to 18 institutions in the United States was completed by 18 attending urologists from 15 institutions.
  
  
  RESULTS
  From among a total of 1651 procedures, there were 46 neuromuscular injuries in 45 patients (2.7%), including abdominal wall neuralgia (14), extremity sensory deficit (12), extremity motor deficit (8), clinical rhabdomyolysis (6), shoulder contusion (4), and back spasm (2). Neuromuscular injuries were twice as common with upper retroperitoneal as with pelvic laparoscopy (3. 1% versus 1.5%). Among patients with neuromuscular injuries, those with rhabdomyolysis were heavier (means 91 versus 80 kg) and underwent longer procedures (means 379 versus 300 minutes), and those with motor deficits were older (means 51 versus 42 years of age). Of the surgeons, 28% and 17% reported frequent neck and shoulder pain, respectively.
  
  
  CONCLUSIONS
  Although not common, neuromuscular injuries during laparoscopy do contribute to morbidity. Abdominal wall neuralgias, injuries to peripheral nerves, and joint or back injuries likely occur no more frequently than during open surgery, but risk of rhabdomyolysis may be increased. Positioning in a partial rather than full flank position may reduce the incidence of some injuries. Measures to reduce neuromuscular strain on the surgeon during laparoscopy should be considered.
authors.affiliation: University of Michigan, Ann Arbor, Michigan 48109-0330, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Wolf
authors.forename: R
authors.initials: R
authors.lastname: Marcovich
authors.forename: I S
authors.initials: IS
authors.lastname: Gill
authors.forename: G T
authors.initials: GT
authors.lastname: Sung
authors.forename: L R
authors.initials: LR
authors.lastname: Kavoussi
authors.forename: R V
authors.initials: RV
authors.lastname: Clayman
authors.forename: E M
authors.initials: EM
authors.lastname: McDougall
authors.forename: A
authors.initials: A
authors.lastname: Shalhav
authors.forename: M D
authors.initials: MD
authors.lastname: Dunn
authors.forename: J S
authors.initials: JS
authors.lastname: Afane
authors.forename: R G
authors.initials: RG
authors.lastname: Moore
authors.forename: R O
authors.initials: RO
authors.lastname: Parra
authors.forename: H N
authors.initials: HN
authors.lastname: Winfield
authors.forename: R E
authors.initials: RE
authors.lastname: Sosa
authors.forename: R N
authors.initials: RN
authors.lastname: Chen
authors.forename: M E
authors.initials: ME
authors.lastname: Moran
authors.forename: S Y
authors.initials: SY
authors.lastname: Nakada
authors.forename: B D
authors.initials: BD
authors.lastname: Hamilton
authors.forename: D M
authors.initials: DM
authors.lastname: Albala
authors.forename: F
authors.initials: F
authors.lastname: Koleski
authors.forename: S
authors.initials: S
authors.lastname: Das
authors.forename: J B
authors.initials: JB
authors.lastname: Adams
authors.forename: T J
authors.initials: TJ
authors.lastname: Polascik
mesh_terms: D000009:Abdominal Muscles / Q000293:injuries / Q000294:innervation; D000328:Adult; D019567:Back Injuries / Q000209:etiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000209:etiology; D009784:Occupational Diseases / Q000209:etiology; D059348:Peripheral Nerve Injuries; D012206:Rhabdomyolysis / Q000209:etiology; D012307:Risk Factors; D020069:Shoulder Pain / Q000209:etiology; D013180:Sprains and Strains / Q000209:etiology; D013520:Urologic Surgical Procedures / Q000009:adverse effects*