Abstract
In a 46-year-old woman with bloody stools colonoscopy revealed rectal cancer 10cm from the anal verge. Laparoscopy-assisted low anterior resection was performed and the patient was set in the 20°head down and 20°right side down position during the operation. Both arms were 70-80°abducted and shoulder braces were placed over both acromioclavicular joints. The operation time was 6h25m and the patient moved four times during the operation, such that anesthetic depth needed to be adjusted. Right after the operation, the patient began to complain of left arm palsy. Several examinations revealed a diagnosis of left brachial plexus palsy due to improper positioning during the operation and the patient was treated conservatively with physiotherapy and rehabilitation. For laparoscopy-assisted surgery, patients sometimes must be placed differently from the positioning for laparotomy. Several reports mention neuropathy due to improper positioning during laparoscopy-assisted surgery. To avoid nerve injuries due to malpositioning, a better understanding of positioning during surgery should be kept in mind by surgeone.
