婦人科腹腔鏡下手術時の体位に関する検討～術後腕神経叢障害の発症経験から～

抄録

  Postoperative brachial plexus injuries infrequently occur after laparoscopic surgery. We describe postoperative brachial plexus injuries after laparoscopic myomectomy (LM), with analysis of the cause and method of prevention. Case 1: a 30-year-old female with body mass index (BMI) 22.0 kg/m² underwent LM. During the procedure, the left upper limb was placed at her side and the right upper limb was abducted; both shoulders were fixed. The head was lowered a maximum of 20 degrees. She developed a right median nerve injury and weakness on right shoulder and elbow flexion after awakening. Electromyography diagnosed a brachial plexus injury and the patient started a rehabilitation program. Case 2: a 36-year-old female with BMI 17.4 kg/m² underwent LM. The position was the same as in case 1. She developed hypoesthesia involving the median, radial, and musculocutaneous nerves in the right hand, and weakness of right elbow flexion and finger movement after awakening. Electromyography diagnosed a brachial plexus injury and the patient started a rehabilitation program. These neurological injuries may have developed when the brachial plexus was sandwiched between the clavicle and first rib in abduction, with overextension due to the weight of the head. Compression of the thoracic outlet is prevented by fixing both upper limbs at the sides and avoiding overextension of the neck with the head fixed. Neurological injuries have not recurred since this positioning method was introduced.