title: Positioning injuries associated with robotic assisted urological surgery.
abstract: OBJECTIVE
  Nerve injury associated with patient positioning during surgery is well documented. With the development of robotic surgery, surgeons are faced with new surgical positioning, requiring attention to ensure patient safety. Published reports that address positioning injury during robotic surgery are sparse and none address the overall incidence. In this study we determine the incidence of positioning injury during robotic assisted urological surgery, identify risk factors and describe the time to resolution of the neurological injury.
  
  
  METHODS
  We reviewed all adult urological cases at our institution that used the da Vinci® Si and da Vinci Standard® Surgical System from January 2010 to December 2011. We characterized risk factors into the 4 domains of positioning, operative, patient specific and anesthesia related. Within these 4 categories we collected data on 13 specific aspects of patient care to determine their association with positioning injury.
  
  
  RESULTS
  Of 334 operations 22 positioning injuries (6.6%) were documented. Of these injuries 13 (59.1%) resolved within 1 month, 4 (18.2%) resolved between 1 and 6 months, and 5 (22.7%) persisted beyond 6 months. We found operative time (p <0.0001), in-room time (p <0.0001) and ASA (American Society of Anesthesiologists) class (p = 0.0033) were significantly associated with injury.
  
  
  CONCLUSIONS
  Positioning injuries are under recognized in robotic assisted urological surgery and may persist beyond 6 months. Consideration must be given to counseling patients about the risks of positioning injuries, especially for long operations. Patients with multiple medical comorbidities (ASA class 4) are particularly at risk for these injuries.
authors: Department of Urology, University of Virginia, Charlottesville, Virginia, USA.
authors: James T
authors: JT
authors: Mills
authors: Michael B
authors: MB
authors: Burris
authors: Daniel J
authors: DJ
authors: Warburton
authors: Mark R
authors: MR
authors: Conaway
authors: Noah S
authors: NS
authors: Schenkman
authors: Tracey L
authors: TL
authors: Krupski
mesh_terms: D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D016015:Logistic Models; D008297:Male; D056888:Patient Positioning; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics; D016896:Treatment Outcome; D013519:Urogenital Surgical Procedures / Q000009:adverse effects*; D014570:Urologic Diseases / Q000601:surgery*
keywords: BMI; IV; body mass index; complications; intravenous; nervous system; patient positioning; robotics; trauma; urogenital system