Evaluation of Positioning Devices for Optimization of Outcomes in Laparoscopic and Robotic-Assisted Gynecologic Surgery

The objective of this review was to assess techniques, devices, and equipment for patient positioning and their effect on patient outcomes, such as cephalad slide and neuropathy, in laparoscopic and robotic-assisted gynecologic surgery. We conducted a systematic review by searching MEDLINE, EMBASE, and Cochrane over 15 years. Study selection, data extraction, and quality assessment were performed by two reviewers independently. Seven articles were included for analysis: three randomized controlled trials, four case series. Four studies evaluated cephalad patient slide. The mean slide with various devices (memory foam, bean bag with shoulder braces, egg crate, gel pad) ranged from 1.07 cm to 4.5 cm (SD range 1.93 cm to 4.0 cm) in two randomized controlled trials (n=103). The use of bean bag with shoulder supports/braces was associated with minimal slide, with median slide of 0 cm (0-2 cm) in a retrospective series and with mean slide of 1.07±1.93 cm in a randomized controlled trial (vs memory foam). No conclusive effect of BMI on slide could be identified. Five studies evaluated the incidence of neuropathy with a 0.16% incidence and no difference according to slide-preventing device. The minimal slide described across studies supports a conclusion that any of the currently used devices and techniques for safe patient positioning are within reason. The low overall incidence of neuropathy is also reassuring. Best- evidence recommendations cannot be made for one specific device ...
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research