Brachial Plexus Injury after Laparoscopic and Robotic Surgery

Received 11 January 2010; accepted 25 February 2010.

Abstract

The objective of this article was to review the literature regarding brachial plexus injury (BPI) in laparoscopic and robotic surgery. BPI complicates gynecologic laparoscopic surgery with an estimated incidence of 0.16%. Nevertheless, as the numbers of advanced laparoscopic and robotic procedures increase, the anticipated risk of this complication may rise as well. Robotic surgery often requires steeper Trendelenburg positioning and longer operative times when compared with traditional laparoscopic surgery. In this article we review the anatomy, pathophysiology, diagnosis, and treatment of position-related BPI in the context of laparoscopic and robotic gynecologic surgery. We suggest a multidisciplinary approach to the diagnosis and treatment of BPI. Recommendations for prevention of this complication are also provided.

Keywords: Brachial plexus injury, Laparoscopy, Robotic surgery, Trendelenburg position

a Departments of Obstetrics and Gynecology, Section of Female Pelvic Medicine and Reconstructive Surgery, Washington Hospital Center, Washington, DC

b National Rehabilitation Hospital, Washington, DC

Corresponding author: David Shveiky, MD, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Washington Hospital Center, 106 Irving Street NW Suite 2100N, Washington, DC 20010.

The authors do not have any conflicts of interest or financial disclosures.

PII: S1553-4650(10)00086-5

doi:10.1016/j.jmig.2010.02.010

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