Cargando…

Neural Monitoring for Robotic Abdominal Wall Reconstruction

INTRODUCTION: Positioning-related neural injuries are an inherent risk in surgery, particularly in robotic-assisted abdominal wall reconstruction because of unique patient positioning and increased operative times. The implementation of intraoperative neurophysiological monitoring should be consider...

Descripción completa

Detalles Bibliográficos
Autores principales: Halpern, David K., Liu, Helen H., Howell, Raelina S., Halpern, Robert A., Akerman, Meredith, Conlon, Joseph, Weidler, Christopher
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Society of Laparoendoscopic Surgeons 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7173774/
https://www.ncbi.nlm.nih.gov/pubmed/32327919
http://dx.doi.org/10.4293/JSLS.2020.00009
_version_ 1783524508112519168
author Halpern, David K.
Liu, Helen H.
Howell, Raelina S.
Halpern, Robert A.
Akerman, Meredith
Conlon, Joseph
Weidler, Christopher
author_facet Halpern, David K.
Liu, Helen H.
Howell, Raelina S.
Halpern, Robert A.
Akerman, Meredith
Conlon, Joseph
Weidler, Christopher
author_sort Halpern, David K.
collection PubMed
description INTRODUCTION: Positioning-related neural injuries are an inherent risk in surgery, particularly in robotic-assisted abdominal wall reconstruction because of unique patient positioning and increased operative times. The implementation of intraoperative neurophysiological monitoring should be considered in such cases. METHODS: This was a two-armed study with one prospective intervention group and one retrospective control group. All patients underwent robotic abdominal wall reconstruction at an academic center. The prospective arm underwent robotic reconstruction from January through July 2019. The retrospective database reviewed patients who underwent the same procedure from August 2015 through July 2018. Factors assessed included: demographics (age, gender, body mass index, comorbidities), surgical details (American Society of Anesthesiologists class, procedure, operative time, positioning), outcomes (length of stay, 30-d readmission, reoperation), and any new-onset intraoperative or postoperative neuropathy. Patients were seen in the clinic postoperatively at weeks 1 and 6. RESULTS: Ten patients were included in the prospective arm. All received intraoperative neurophysiological monitoring using somatosensory evoked potentials. They were compared with 47 patients in the retrospective arm who underwent surgery without intraoperative neurophysiological monitoring. One position-related neural response from baseline was detected intraoperatively in the prospective arm; however, there were no peripheral neurological symptoms present postoperatively. Two patients in the control group developed transient peripheral neuropathies that resolved within 6 weeks. Demographics, surgical procedures, and length of surgery were similar in both groups. The prospective group had a higher rate of preoperative neuropathy and intraoperative use of vasopressors. CONCLUSION: Incorporation of neurophysiological monitoring in robotic surgery is feasible and may lead to the prevention and reduction in positioning-related injuries.
format Online
Article
Text
id pubmed-7173774
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Society of Laparoendoscopic Surgeons
record_format MEDLINE/PubMed
spelling pubmed-71737742020-04-23 Neural Monitoring for Robotic Abdominal Wall Reconstruction Halpern, David K. Liu, Helen H. Howell, Raelina S. Halpern, Robert A. Akerman, Meredith Conlon, Joseph Weidler, Christopher JSLS Research Article INTRODUCTION: Positioning-related neural injuries are an inherent risk in surgery, particularly in robotic-assisted abdominal wall reconstruction because of unique patient positioning and increased operative times. The implementation of intraoperative neurophysiological monitoring should be considered in such cases. METHODS: This was a two-armed study with one prospective intervention group and one retrospective control group. All patients underwent robotic abdominal wall reconstruction at an academic center. The prospective arm underwent robotic reconstruction from January through July 2019. The retrospective database reviewed patients who underwent the same procedure from August 2015 through July 2018. Factors assessed included: demographics (age, gender, body mass index, comorbidities), surgical details (American Society of Anesthesiologists class, procedure, operative time, positioning), outcomes (length of stay, 30-d readmission, reoperation), and any new-onset intraoperative or postoperative neuropathy. Patients were seen in the clinic postoperatively at weeks 1 and 6. RESULTS: Ten patients were included in the prospective arm. All received intraoperative neurophysiological monitoring using somatosensory evoked potentials. They were compared with 47 patients in the retrospective arm who underwent surgery without intraoperative neurophysiological monitoring. One position-related neural response from baseline was detected intraoperatively in the prospective arm; however, there were no peripheral neurological symptoms present postoperatively. Two patients in the control group developed transient peripheral neuropathies that resolved within 6 weeks. Demographics, surgical procedures, and length of surgery were similar in both groups. The prospective group had a higher rate of preoperative neuropathy and intraoperative use of vasopressors. CONCLUSION: Incorporation of neurophysiological monitoring in robotic surgery is feasible and may lead to the prevention and reduction in positioning-related injuries. Society of Laparoendoscopic Surgeons 2020 /pmc/articles/PMC7173774/ /pubmed/32327919 http://dx.doi.org/10.4293/JSLS.2020.00009 Text en © 2020 by JSLS, Journal of the Society of Laparoscopic & Robotic Surgeons. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/us/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.
spellingShingle Research Article
Halpern, David K.
Liu, Helen H.
Howell, Raelina S.
Halpern, Robert A.
Akerman, Meredith
Conlon, Joseph
Weidler, Christopher
Neural Monitoring for Robotic Abdominal Wall Reconstruction
title Neural Monitoring for Robotic Abdominal Wall Reconstruction
title_full Neural Monitoring for Robotic Abdominal Wall Reconstruction
title_fullStr Neural Monitoring for Robotic Abdominal Wall Reconstruction
title_full_unstemmed Neural Monitoring for Robotic Abdominal Wall Reconstruction
title_short Neural Monitoring for Robotic Abdominal Wall Reconstruction
title_sort neural monitoring for robotic abdominal wall reconstruction
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7173774/
https://www.ncbi.nlm.nih.gov/pubmed/32327919
http://dx.doi.org/10.4293/JSLS.2020.00009
work_keys_str_mv AT halperndavidk neuralmonitoringforroboticabdominalwallreconstruction
AT liuhelenh neuralmonitoringforroboticabdominalwallreconstruction
AT howellraelinas neuralmonitoringforroboticabdominalwallreconstruction
AT halpernroberta neuralmonitoringforroboticabdominalwallreconstruction
AT akermanmeredith neuralmonitoringforroboticabdominalwallreconstruction
AT conlonjoseph neuralmonitoringforroboticabdominalwallreconstruction
AT weidlerchristopher neuralmonitoringforroboticabdominalwallreconstruction