Impact of patient positioning during surgery on neuropathies after robot‐assisted laparoscopic radical prostatectomy: a randomised controlled trial

ObjectiveTo investigate whether ankle braces or shoulder support used for fixation during robot‐assisted radical prostatectomy (RARP), where patients are commonly positioned in the head‐down Trendelenburg position, differ in their potential to cause peripheral nerve injury.Patients and MethodsA prospective, double‐blind, randomised controlled trial was conducted on patients undergoing RARP for prostate cancer between May 2020 and September 2021 using the da Vinci® Si system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Patients were randomly assigned to either the shoulder or ankle brace fixation group and were positioned in a modified lithotomy position. Neurological examinations were performed pre‐ and postoperatively. The primary endpoint was the prevalence of any peripheral neuropathy on the first postoperative day.ResultsA total of 98 patients were treated using the da Vinci Si system: 46 in the lithotomy lower fixation group and 52 in the lithotomy upper fixation group. Both groups mainly recorded neuropathies in the lower extremity, with a total incidence of 6.9% for lower neuropathies and 3.9% for upper neuropathies. All neuropathies were sensory, with one exception in the upper fixation group presenting a motor deficit. Over a median follow‐up of 12 months, no neuropathies persisted. Neuropathy on the first postoperative day was observed in 15% of patients in the upper fixation group and 6.5% in the lower fixation group (P = 0.2).ConclusionWe observed neuropathies in a clinically relevant proportion of men undergoing RARP. We were not able to demonstrate a significant difference regarding postoperative neuropathies between ankle braces or shoulder support during RARP.