Session: MP67: Prostate Cancer: Localized: Surgical Therapy III
MP67-17: Placement of appropriate surgical position by measuring lower leg pressure prevents the development of creatine kinase elevation and leg compartment syndrome after robot-assisted radical prostatectomy.
Department of Urology Fukuhsima Medcical Uciversity
Introduction: One of the serious complications of robot-assisted radical prostatectomy (RARP) is leg compartment syndrome (LCS), which can cause permanent nerve and muscle damage. In this study, we focused on lower leg pressure during a steep Trendelenburg position in RARP, and examined whether the placement of an appropriate surgical position by measuring lower leg pressure could prevent the development of creatine kinase (CK) elevation and LCS after RARP. Methods: A total of 300 patients who underwent RARP at our institution were investigated between August 2018-August 2022. The patients were divided into two groups, pressure measurement and non-measurement groups. In the pressure measurement group, lower leg pressure was measured by Portable Interface Pressure Sensor (Palm Q®), and the surgical position was made so that the leg pressure was around 10~15 mmHg. Postoperative CK values and LCS incidence were compared between the two groups using the Mann-Whitney's U test. Results: The pressure measurement group showed significantly lower CK values (POD1) compared to the pressure non-measurement group (768 ± 1,045 IU/L vs 1,665 ± 3640 IU/L, respectively, p<0.05). There were no significant differences in console time and BMI between the two groups (234 ± 61 min vs 240 ± 57 min, 24.7 ± 3.2 kg/m2 vs 24.6 ± 3.2 kg/m2, p=0.427, p=0.577, respectively). Postoperative lower leg pain symptoms were observed in 0 patients in the measurement group but 4 patients in the non-measurement group, with a significant difference between the 2 groups (p < 0.05). Two of them were diagnosed with LCS. Conclusions: The placement of an appropriate surgical position by measuring lower leg pressure is important. In particular, positioning the patient with a lower leg pressure of 10-15 mmHg may prevents the development of postoperative CK elevation and LCS. SOURCE OF Funding: Nothing.
