DOI: h ps://doi.o g/10.1097/jn .0000000000000530
Fac o s Associa ed Wi h Pe iphe al Ne e
Inju y A e Pel ic Lapa oscopy: The
Impo ance o Su gical Posi ioning
Ainhoa ZARANDONA DEL CAMPO
1
*•Ne ea HERREROS MARIAS
1
•Alazne TORVISCO MACIAS
2
•
Ana Ma ía BARANDICA BILBAO
3
•Lo ea RODRIGUEZ OTAZUA
1
•U ko AGUIRRE LARRACOECHEA
4
•
Ane VILLANUEVA ETXEBARRIA
4
•Vicen e PORTUGAL PORRAS
5
In oduc ion
Pe iphe al ne e inju y (PNI) ep esen s a a e bu po en-
ially se ious isk a e abdominal and pel ic su ge y. The in-
cidence o his ype o inju y is di icul o assess, wi h p io
s udies epo ing a es anging be ween 0.02% and 21%
(Bouye -Fe ullo, 2012; Na a o-Vicen e e al., 2011). Such
inju ies occu a e a pe iphe al mo o ne e is o n, cu , o
comp essed and muscles a e subsequen ly dene a ed when
he dis al b anches o ha ne e become weak o pa alyzed
and mo o unc ion dis al o he le el o he inju y is impai ed
o los .
Such inju ies may become e iden as soon as a pa ien
egains consciousness o a ew days a e su ge y and may
ha e se ious unc ional consequences. In addi ion o he sig-
ni ican social and heal h impac s, hese ypes o inju y ha e
po en ial medicolegal implica ions (Akha an e al., 2010), as
hey show a ailu e o ensu e he sa e y o pa ien s unde going
su ge y. Ne e inju ies accoun ed o 22% o he malp ac ice
claims in he Ame ican Socie y o Anes hesiologis s Closed
Claims Da abase be ween 1990 and 2007 (Welch, 2017).
A ecen sys ema ic e iew o he li e a u e con i med wo
ypes o isk ac o s o PNI: indi idual pa ien - ela ed ac o s
and pe iope a i e su ge y- ela ed ac o s (Abdalmageed e al.,
2017). The o me includes diabe es melli us, a low body mass
index (BMI), and age, whe eas he la e include su gical ime,
he use o comp ession s ockings (Güzelküçük e al., 2014), ac-
o s ela ed o pa ien posi ioning, and ce ain in aope a i e
e en s such as hypoxia, hypo ension, and signi ican blood loss.
Fu he mo e, lapa oscopic su ge y o en en ails longe su gical
imes, mo e di icul su gical posi ions (Agos ini e al., 2010),
and mo e ixa ion sys ems o pe o m he su ge y, which a e
ac o s ha may exace ba e PNI isk.
1
BSN, RN, Pe iope a i e Su gical A ea, Depa men o Gene al
Su ge y, Galdakao-Usansolo Hospi al, Galdakao, Bizkaia, Spain •
2
MSc, RN, Pe iope a i e Su gical A ea, Depa men o U ology,
Galdakao-Usansolo Hospi al, Galdakao, Bizkaia, Spain •
3
BSN, RN,
Pe iope a i e Su gical A ea, Depa men o Gynecology,
Galdakao-Usansolo Hospi al, Galdakao, Bizkaia, Spain •
4
MSc,
Bios a is ician Resea ch Uni , Galdakao Usansolo Hospi al, Galdakao,
Bizkaia; K onikgune Ins i u e o Heal h Se ices Resea ch, Ba akaldo,
Bizkaia; and Heal h Se ices Resea ch on Ch onic Pa ien s Ne wo k
(Redissec), Bilbao, Bizkaia, Spain •
5
PhD, Consul an Su geon and
P o esso , Depa men o Gene al Su ge y, Facul y o Medicine and
Su ge y, Uni e si y o he Basque Coun y, and Head o Colo ec al
Su ge y, Galdakao Usansolo Hospi al, Galdakao, Bizkaia, Spain.
Copy igh © 2023 The Au ho s. Published by Wol e s Kluwe Heal h, Inc.
This is an open access a icle dis ibu ed unde he C ea i e Commons
A ibu ion License 4.0 (CCBY), which pe mi s un es ic ed use, dis i-
bu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is
p ope ly ci ed.
ABSTRACT
Backg ound: Ne e damage a e abdominal and pel ic su ge y
is a e bu po en ially se ious. The incidence o pe iphe al ne e
inju y is di icul o assess, and a es o be ween 0.02% and
21% ha e been ci ed in he li e a u e. Signs and symp oms o
his ype o inju y may appea immedia ely a e su ge y o a
ew days la e .
Pu pose: This s udy was de eloped o assess he a e o pe-
iphe al ne e inju y a e pel ic lapa oscopy and o iden i y as-
socia ed isk ac o s.
Me hods: A pilo p ospec i e coho s udy was conduc ed be-
ween Ma ch 2018 and Ap il 2019 on 101 pa ien s wi h a
1-mon h ollow-up using wo semis uc u ed clinical in e iews.
We ca ied ou a desc ip i e analysis ollowed by uni a iable
and mul i a iable logis ic eg ession analyses.
Resul s: Thi een pa ien s we e ound o ha e pe iphe al ne e
inju ies, ep esen ing a a e o 12.9%. O e all, 14 inju ies ( i e
se e e and nine mild) we e de ec ed. One pa ien had wo mild
inju ies. In his s udy, he isk o inju y was ound o inc ease
1.77- old (OR = 1.77, 95% CI [1.13, 2.76], p= .007) o each
hou he pa ien was in he T endelenbu g posi ion.
Conclusions/Implica ions o P ac ice: The longe he pa ien
is in he T endelenbu g posi ion, he g ea e he isk o pe iph-
e al ne e damage. Pa ien s aged 60 yea s o less also ace a
highe isk o ne e inju y.
KEY WORDS:
pe iphe al ne e inju y, pa ien posi ioning, lapa oscopy,
ne e inju y, T endelenbu g.
ORIGINAL ARTICLE The Jou nal o Nu sing Resea ch ▪VOL. 31, NO. 1, FEBRUARY 2023
1
The main objec i es o his s udy we e o assess he inci-
dence o PNI and iden i y associa ed isk ac o s.
Me hods
We conduc ed a pilo obse a ional p ospec i e coho s udy
a e ecei ing app o al o his esea ch om he E hics
Commi ee o Galdakao-Usansolo Uni e si y Hospi al (Re -
e ence Numbe 05/18). We ec ui ed pa ien s unde going
pel ic lapa oscopy unde he ca e o gene al, u ological, o
gynecological su ge y eams be ween Feb ua y 2018 and
Ap il 2019. The common elemen in all o hese p ocedu es
was he use o T endelenbu g posi ion. The ypes o p oce-
du es conduc ed by he gene al su ge y eam included le
hemicolec omy, sigmoidec omy, o al colec omy, low and ul-
alow an e io esec ion, and abdominope ineal esec ion
(i.e., colop oc ological p ocedu es), whe eas o al and adical
hys e ec omy p ocedu es we e conduc ed by he gynecology
eam, and adical p os a ec omy and adical cys ec omy p o-
cedu es we e conduc ed by he u ology eam.
Because p e ious s udies ha e iden i ied p olonged su gi-
cal ime as a isk ac o (Abdalmageed e al., 2017; Al-
Temimi e al., 2017; Elleb ech e al., 2015), all pa ien s aged
18 yea s old and abo e who had unde gone su ge y las ing
o e 2 hou s ( om he s a o he closu e o he su gical in-
cision) we e ec ui ed as pa icipan s. We excluded pa ien s
wi h spinal co d inju y, neu odegene a i e disease, p eexis -
ing ne e damage in a limb, and/o demen ia. Pa ien s we e
in o med e bally ha pa icipa ion was olun a y, and
w i en in o med consen was ob ained om hem o hei le-
gal ep esen a i es be o e inclusion.
Da a we e ga he ed p eope a i ely on pa ien - ela ed a -
iables (Abdalmageed e al., 2017; Al-Temimi e al., 2017;
Welch, 2017), including age, gende , pe iope a i e Ame ican
Socie y o Anes hesiologis s isk, BMI, special y in cha ge,
and ca ego y o diagnosis. Da a we e ga he ed in aope a i ely
on pe iope a i e a iables, including ype o in e en ion, he
use o con en ional comp ession s ockings o in e mi en
pneuma ic comp ession (Güzelküçük e al., 2014; Kim e al.,
2016), he use o Allen shoulde suppo s, o al du a ion o
he su gical in e en ion, and ime in minu es (Boh e e al.,
2009) spen in he T endelenbu g posi ion (T eszezamsky
e al., 2017) and in he le o igh la e al posi ions.
We assessed each pa ien 48 hou s a e he su ge y using
a semis uc u ed clinical in e iew o he ollowing symp-
oms: weakness, ingling, loss o s eng h, c amps, pain,
and abno mal limb mo emen s. Pa ien s we e conside ed
o ha e clinically suspec ed PNI i hey ga e a posi i e e-
sponse o any ques ionnai e i em (Kuma e al., 2019), and
his suspicion was no i ied o he doc o in cha ge. The inju-
ies we e con i med by medical diagnosis and we e classi ied
as mild o se e e. Cases in which he inju y was sel -limi ing,
ha is, which esol ed spon aneously o wi h pha macolog-
ical ea men , we e conside ed o be mild, whe eas inju ies
equi ing su gical and/o ehabili a ion ea men o ook
longe han 60 days o esol e we e conside ed o be se e e.
A second semis uc u ed in e iew was ca ied ou o e
he phone 1 mon h a e he ini ial su ge y o assess he p es-
ence o absence o he symp oms iden i ied in he i s in e -
iew as well as he onse o new symp oms and he need
o medical o ehabili a ion ea men .
S a is ical Analysis
The desc ip i e analysis cons uc ed equency and pe cen -
age ables o he ca ego ical a iables and calcula ed means,
s anda d de ia ions, medians, and in e qua ile anges o
he con inuous a iables. Nex , uni a iable analyses we e
pe o med o iden i y (a) di e ences be ween su gical spe-
cial ies and (b) isk ac o s ela ed o he de elopmen o
PNI. Ca ego ical a iables we e compa ed using chi-squa ed
o Fishe 's exac es s, whe eas con inuous a iables we e
compa ed using S uden 's es o nonpa ame ic Wilcoxon
and K uskal–Wallis es s.
To iden i y he isk ac o s o PNI, a iables ha we e sig-
ni ican a he .2 le el in he uni a iable analysis we e consid-
e ed as po en ial independen a iables o i he mul i a iable
logis ic eg ession model. In all cases, he inal p edic i e ac-
o s we e hose ha we e signi ican a he .05 le el. Odds a-
ios (ORs) and 95% con idence in e als (CIs) we e calcula ed.
The goodness o i o he model was assessed using he
Hosme –Lemeshow es . The p edic i e powe o he model
was analyzed by calcula ing he a ea unde he ecei e ope -
a ing cha ac e is ic cu e (AUC) and he co esponding CI
using he boo s ap esampling me hod wi h 2,000 samples.
Finally, he esul s ob ained in he clinical in e iews a
48 hou s and 1 mon h a e su ge y we e compa ed using
McNema 's es . All o he s a is ical analyses we e pe o med
using SAS o Windows Ve sion 9.4 (SAS Ins i u e, Ca y, NC,
USA) and R Ve sion 4.0.0.
Resul s
One hund ed one pa ien s we e en olled as pa icipan s du -
ing he s udy pe iod, wi h a mean age o 66.3 (SD = 10.4)
yea s. Thi y- ou (33.6%) we e women. Rega ding he dis i-
bu ion by su gical special y, 50 (49.5%) we e colop oc ology
pa ien s, 41 (40.6%) we e u ology pa ien s, and 10 (9.9%)
we e gynecology pa ien s. Mean age and BMI we e simila
in pa icipan s ac oss he h ee su gical special ies. U ology
pa ien s had he highes inju y a e (n=10, 24.4%; p=.015).
In his subg oup (u ology), he pa icipan s had longe o al
imes bo h in su ge y and in he T endelenbu g posi ion
(p< .001 in bo h cases; Table 1).
Pa ien s wi h PNI had longe imes in su ge y o e all (335
[300–440] s. 275 [210–350] minu es, p= .002) and in he
T endelenbu g posi ion (285 [220–385] s. 218 [145–270]
minu es, p= .011). Being 60 yea s old o less was posi i ely as-
socia ed wi h ha ing PNI ( p= .018). Howe e , no di e ences
we e iden i ied be ween pa ien s who did and did no de elop
PNI in e ms o gende , BMI, use o shoulde suppo s, o use
o la e al posi ioning (ei he igh o le ; Table 2).
The Jou nal o Nu sing Resea ch Ainhoa ZARANDONA DEL CAMPO e al.
2
Combining he signi ican a iables in he logis ic eg ession
model o p edic ing he isk o PNI, ime in he T endelenbu g
posi ion was posi i ely co ela ed wi h de eloping PNI, wi h
each addi ional hou spen in his posi ion associa ed wi h a
77% inc ease in he p obabili y o de eloping PNI (OR =1.77,
95% CI [1.13, 2.76], p= .007). In addi ion, being 60 yea s old
o less was associa ed wi h a 4.16 imes highe isk o de elop-
ing PNI (OR = 4.16, 95% CI [1.16, 14.92], p= .026). We con-
cluded he i o he model o be good (p= .23 in he Hosme –
Lemeshow es ). The AUC ob ained o his model was 0.8
(95% CI [0.69, 0.91]).
The esul s o he desc ip i e analysis o he symp oms in
he pa icipan s wi h PNI a 48 hou s and 1 mon h a e su ge y
a e summa ized in Table 3. A 48 hou s a e su ge y, 5.0%
epo ed weakness, 11.9% epo ed ingling, 5.0% epo ed
loss o s eng h, 4.0% epo ed c amps, and 6.9% epo ed
pain. None heless, 94.1% epo ed ha ing he same le el
o limb mobili y as hey had be o e su ge y. One mon h la e ,
sligh imp o emen s we e obse ed, bu mos o he pa ici-
pan s wi h PNI con inued o expe ience he same symp oms
as epo ed 48 hou s pos ope a i ely.
Thi een o he 101 pa icipan s de eloped PNI (incidence =
12.9%) du ing he i s 48 hou s a e su ge y. O e all, 14
inju ies we e de ec ed, wi h nine mild cases and i e se e e
cases. Mo eo e , one pa icipan de eloped wo mild inju-
ies. Rega ding he inju y si e, he uppe limbs we e in ol ed
in only ou cases, wi h all o he o he s in ol ing he lowe
limbs. Ten o hese pa icipan s had unde gone u ological
su ge y, and he o he h ee we e gene al su ge y pa ien s.
Mos o he mild inju ies in ol ed pa es hesia (six cases),
Table 1
Desc ip i e Analysis and Compa ison o he Main Va iables, by Special y
Va iable n%Special yp
Colop oc ology
(Gene al Su ge y)
U ology Gynecology
n%n%n%
To al pa icipan s 101 50 49.5 41 40.6 10 9.9
Pa ien cha ac e is ics
Gende <.001
Male 67 66.4 29 58.0 38 92.7 0 0
Female 34 33.6 21 42.0 3 7.3 10 100.0
Age (yea s; Mand SD) 66.3 10.4 67.1 12.5 65.7 5.8 64.6 13.7 .563
Age (yea s), ca ego ized .552
≤60 30 29.7 16 32.0 10 24.4 4 40.0
> 60 71 70.3 34 68.0 31 75.6 6 60.0
Pe sonal his o y
ASA classi ica ion .193
I 12 11.9 5 10.0 5 12.2 2 20.0
II 64 63.4 27 54.0 29 70.7 8 80.0
III 23 22.8 17 34.0 6 14.6 0 0
IV 2 2.0 1 2.0 1 2.4 0 0
Nu i ional s a us
BMI (kg/m
2
;Mand SD) 27.1 4.5 26.5 5.0 27.4 3.9 29.0 4.2 .171
BMI > 30 kg/m
2
19 18.8 9 18.0 6 14.6 4 40.0 .184
In aope a i e da a
Inju ies in he limbs 13 12.9 3 6.0 10 24.4 0 0 .015
Su gical ime
a
285 210–360 280 210–345 310 250–390 180 150–245 < .001
Shoulde suppo s 76 75.3 25 50.0 41 100.0 10 100.0 < .001
Comp ession .006
No 2 2.0 0 0 2 4.9 0 0
Con en ional s ockings 57 56.4 33 66.0 15 36.6 9 90.0
Pneuma ic 42 41.6 17 34.0 24 58.5 1 10.0
T endelenbu g posi ion used 100 99.0 49 98.0 41 100.0 10 100.0 .597
T endelenbu g igh la e al posi ion 46 45.5 46 92.0 0 0 0 0 < .001
T endelenbu g le la e al posi ion 4 4.0 4 8.0 0 0 0 0 .119
Time in T endelenbu g posi ion
a
220 155–278 180 135–245 275 220–350 140 75–180 < .001
No e. ASA = Ame ican Socie y o Anes hesiologis s; BMI = body mass index.
a
Va iables measu ed in minu es. Resul s a e exp essed as median [in e qua ile ange].
Pe iphe al Ne e Inju y A e Pel ic Lapa oscopy VOL. 31, NO. 1, FEBRUARY 2023
3
wi h only one case each o ex e nal popli eal ne e neu op-
a hy, ulna ne e neu op axia, and b achial plexus palsy,
which we e all caused by comp ession. Rega ding inju y
cou se, in six cases, no ea men was equi ed and he con-
di ion esol ed spon aneously. The emaining cases equi ed
pha macological ea men . All o he se e e inju ies in ol ed
he lowe limbs. Th ee o he pa icipan s had muscle ischemia
a ibu able o compa men synd ome ha equi ed eme -
gency ascio omy, wi h wo u he equi ing g a econs uc-
ion as well as ehabili a ion and pha macological ea men .
One o he pa icipan had edema associa ed wi h o hos a ic
hypope usion, which was ea ed using medica ion and com-
p ession s ockings. The las pa ien wi h a se e e lesion had
ex e nal popli eal neu opa hy ha equi ed ehabili a ion
(see Supplemen al Ma e ial, Appendix 1, a ailable a h p://
links.lww.com/JNR/A3).
Discussion
In his s udy, we ound a posi i e associa ion be ween ime in
he T endelenbu g posi ion and isk o PNI, wi h each addi-
ional hou in his posi ion inc easing he isk o ne e inju y
by 77%. The T endelenbu g posi ion is a speci ic posi ion
used o all o he su gical in e en ions equi ing pel ic lap-
a oscopy in his s udy. The pa icipan s who expe ienced se-
e e PNI we e hose who spen he longes ime in his posi-
ion. In addi ion, longe ime in he T endelenbu g posi ion
was associa ed wi h a longe o al ime in su ge y. The esul s
Table 2
Compa isons o he Main Va iables by Whe he Pa ien s Had Limb Ne e Inju y
Va iable Uppe o Lowe Limb Ne e Inju y p
Yes (n=13) No (n=88)
n%n%
Special y .015
Colop oc ology 3 23.1 47 53.4
U ology 10 76.9 31 35.2
Gynecology 0 0.0 10 11.3
Pa ien cha ac e is ics
Gende .055
Male 12 92.3 55 62.5
Female 1 7.7 33 37.5
Age (yea s; Mand SD) 58.6 8.0 67.4 10.2 .004
Age (yea s), ca ego ized .018
≤60 8 61.5 22 25.0
> 60 5 38.5 66 75.0
Pe sonal his o y
ASA classi ica ion .828
I 2 15.4 10 11.4
II 9 69.2 55 62.5
III 2 15.4 21 23.9
IV 0 0.0 2 2.3
Nu i ional s a us
BMI (kg/m
2
;Mand SD) 26.4 4.3 27.2 4.6 .927
BMI > 30 (kg/m
2
)17.71820.7.452
In aope a i e da a
Su gical ime
a
335 300–440 275 210–350 .002
Shoulde suppo s 11 84.6 65 73.9 .510
Comp ession .229
No 1 7.7 1 1.1
Con en ional s ockings 8 61.5 49 55.7
Pneuma ic 4 30.8 38 43.2
T endelenbu g posi ion used 13 100.0 87 98.9 1
T endelenbu g igh la e al posi ion 3 23.1 43 48.9 .081
T endelenbu g le la e al posi ion 1 7.7 3 3.4 .429
Time in T endelenbu g posi ion
a
285 220–385 218 145–270 .011
No e. ASA = Ame ican Socie y o Anes hesiologis s; BMI = body mass index.
a
Va iables measu ed in minu es. Resul s a e exp essed as median [in e qua ile ange].
The Jou nal o Nu sing Resea ch Ainhoa ZARANDONA DEL CAMPO e al.
4
suppo p olonged T endelenbu g posi ioning as a mo e accu-
a e p edic o o PNI. This ela ionship has no been shown in
he p edic i e models epo ed in p e ious s udies, al hough
some au ho s ha e concluded ha he T endelenbu g posi ion
p omo es he de elopmen o PNI. Speci ically, in a 2017 e-
iew, Colsa Gu ié ez e al. (2016) commen ed ha he
T endelenbu g posi ion oge he wi h he use o a m boa ds
and shoulde abduc ion may encou age he de elopmen o
PNI du ing lapa oscopic p ocedu es. Al-Temimi e al. (2017)
men ioned ha he T endelenbu g posi ion may inc ease he
isk o uppe limb neu opa hy. In ou e iew o he li e a u e,
only wo s udies we e ound ha measu ed he ime spen
in his posi ion (Klauschie e al., 2010; T eszezamsky e al.,
2017). Bo h s udies concluded ha pa ien displacemen on
he su gical able was no in luenced by he ime in he
T endelenbu g posi ion and ha his ac o was no iden i-
ied as a isk ac o o he de elopmen o PNI. On he o he
hand, p olonged o al su ge y ime has been shown o in-
c ease his isk (Al-Temimi e al., 2017; Wallis e al., 2017).
Ou indings a e in line wi h hose o p e ious s udies,
which ha e ound pa ien s unde 60 yea s old o be a a
g ea e isk o de eloping PNI (e.g., Al-Temimi e al., 2017).
Howe e , he esul sin hescien i icli e a u ea e e yhe e -
ogenous. Fo example, Na a o-Vicen e e al. (2011) did no
obse e any ela ionship be ween age and PNI, whe eas bo h
Abdalmageed e al. (2017) and Welch (2017)iden i ied being
o e 60 yea s old as a isk ac o o de eloping PNI.
A s eng h o his s udy was he use o p edic i e models
o p edic ing isk o de eloping ne e inju ies. Few s udies
in he li e a u e epo ed conduc ing his ype o analysis
(Al-Temimi e al., 2017; Wallis e al., 2017). The p edic i e
model used in his s udy has an AUC o 0.80 and a good cal-
ib a ion abili y, indica ing i s obus disc imina ion and cali-
b a ion in he p edic ion o PNI.
Despi e he indings o a sys ema ic e iew by Codd e al.
(2013) indica ing ha he b achial plexus is pa icula ly ul-
ne able o ne e inju y du ing colo ec al lapa oscopy and he
claim by Abdalmageed e al. (2017) ha b achial plexus inju-
ies ep esen he mos se ious complica ion caused by inco ec
posi ioning, his s udy ound lowe limb inju ies o be mo e
common and mo e se e e han uppe limb inju ies. The ind-
ings o his s udy a e in line wi h hose o he sys ema ic e iew
by Das e al. (2019), which did no ind an associa ion be-
ween he de elopmen o neu opa hy and he use o shoulde
suppo s. Howe e , o he au ho s (Abdalmageed e al., 2017)
ha e sugges ed ha hei use may be a ele an ac o . In an-
o he s udy, placing pa ien s on a acuum bean-bag posi ione
o a oid he use o shoulde suppo s was ound o educe he
incidence o b achial plexus inju ies o ze o (Na a o-Vicen e
e al., 2011). On he o he hand, Ha ada e al. (2019) used a
p o ocol unde which pa ien s we e o a ed om a la e al o
a supine posi ion e e y 120 minu es such ha he p essu e a
he shoulde would be educed o 5 minu es, he eby a oiding
inju y o he b achial plexus.
In his s udy, we ound no signi ican di e ences be ween
he use o con en ional comp ession s ockings and in e -
mi en pneuma ic comp ession, al hough he la e ap-
p oach has been ecommended (Kim e al., 2016). In a book
chap e , Fille e al. (2016) indica ed ha bo h con en ional
s ockings and in e mi en comp ession may cause damage
by comp essing he pe oneal ne e. Güzelküçük e al. (2014)
emphasized he need o use he co ec s ocking size o e-
duce he isk o ne e inju y.
Acco ding o Al-Temimi e al. (2017), pa ien s wi h a BMI
g ea e han 30 kg/m
2
a e a a g ea e isk o de eloping
ne e inju y. Simila ly, Elleb ech e al. (2015) ela ed he isk
o ne e inju y o obesi y. In his s udy, we ailed o iden i y a
g ea e ulne abili y o PNI among he pa icipan s wi h a
high BMI (> 30 kg/m
2
).
U ological su ge y was associa ed wi h a highe a e o
ne e inju ies in his s udy, likely because o he longe su gi-
cal imes and he s eepe T endelenbu g posi ion used a he
han o he cha ac e is ics o he special y i sel . Bjø o e al.
(2019) concluded ha he li ho omy posi ion wi h a s eep
T endelenbu g posi ion may lead o PNI bu ha compa i-
sons be ween di e en su gical p ocedu es a e hinde ed by
a lack o alid ins umen s o iden i y a PNI, making i di i-
cul o assess he incidence.
I is likely ha , as no ed by o he au ho s (Fille e al.,
2016; Welch, 2017), PNI will con inue o occu despi e e -
o s o adop p e en i e measu es. The da a collec ed in his
s udy did no allow ou iden i ica ion o he op imal pa ien
posi ion o ne e inju y a oidance. Ne e heless, we con-
side i essen ial o ain su gical eams and aise awa eness
o he isk and consequences o hese ypes o inju y. Reco d-
ing a pa ien 's posi ioning is an impo an s ep in inc easing
awa eness o how o p e en PNI, as shown in he pilo s udy
o Bouye -Fe ullo e al. (2015). One o ou u u e p io i ies is
hus o de elop a o m o acili a e he eco ding o pa ien
posi ioning du ing su ge y o use in u u e esea ch.
Table 3
Desc ip i e Analysis: In e iews Conduc ed a
48 Hou s and 1 Mon h A e Su ge y
Symp om In e iew a
48 Hou s
(n= 101)
In e iew a
1 Mon h
(n= 101)
p
n%n%
Weakness 5 5.0 6 5.9 .757
Tingling 12 11.9 12 11.9 1
Loss o s eng h 5 5.0 6 5.9 .757
C amps 4 4.0 2 2.0 .407
Pain in a leas one limb 7 6.9 6 5.9 .774
Able o mo e all limbs
spon aneously/ in
esponse o ins uc ions
95 94.1 96 95.1 .757
Simila o be o e su ge y 94 94.0 96 95.1 .744
Pe iphe al Ne e Inju y A e Pel ic Lapa oscopy VOL. 31, NO. 1, FEBRUARY 2023
5
Limi a ions
The limi a ions o his s udy include he small numbe o gy-
necological pa ien s included because o human esou ce
managemen p oblems and he o e all sample size because
o he aming o his esea ch as pilo s udy.
In he u u e, he deg ee o T endelenbu g il should be
measu ed and posi ions may be changed in e mi en ly o
a oid il ing pa ien s when no necessa y o educe he ime
pa ien s spend in his cons ained posi ion and allow blood
low o be es o ed o he lowe limbs o educe he isk
o ischemia.
Acknowledgmen s
This s udy was suppo ed by a 600-eu o g an om he Basque
Founda ion o Heal h Inno a ion and Resea ch. The au ho s
would like o hank all o he nu sing s a and he u ology eam
who dedica ed ime and e o o help wi h his s udy. They a e
also pa icula ly g a e ul o he s a o he esea ch uni o
Galdakao Hospi al. Wi hou all o hese people, i would
no ha e been possible o ca y ou his s udy.
Au ho Con ibu ions
S udy concep ion and design: AZDC, NHM, VPP
Da a collec ion: AZDC, NHM, AMBB, LRO, ATM
Da a analysis and in e p e a ion: UAL, AVE
D a ing o he a icle: AZDC, NHM, AMBB, LRO, ATM,
UAL, AVE
C i ical e ision o he a icle: UAL, AVE
Recei ed: Janua y 21, 2021; Accep ed: Oc obe 14, 2021
*Add ess co espondence o: Ainhoa ZARANDONA DEL CAMPO,
BSN, RN, Ma ia Nie es Gallas egi 10A, Galdakao 48960, Bizkaia, Spain. Tel:
+34 667755891; E-mail: ainhoa.za andonadelcampo@osakide za.eus
The au ho s decla e no con lic s o in e es .
Supplemen al digi al con en is a ailable o his a icle. Di ec URL
ci a ions appea in he p in ed ex and a e p o ided in he HTML and PDF
e sions o his a icle on he jou nal’s Web si e (www.jn - wna.com).
Ci e his a icle as:
Za andona del Campo, A., He e os Ma ias, N., To isco Macias, A.,
Ba andica Bilbao, A. M., Rod iguez O azua, L., Agui e La acoechea,
U., Villanue a E xeba ia, A., & Po ugal Po as, V. (2023). Fac o s
associa ed wi h pe iphe al ne e inju y a e pel ic lapa oscopy: The
impo ance o su gical posi ioning. The Jou nal o Nu sing Resea ch,
31(1), A icle e259. h ps://doi.o g/10.1097/jn .0000000000000530
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