Search Results (4)

Background/Objectives: Well-leg compartment syndrome is a rare but potentially life-threatening complication associated with the lithotomy position during pelvic or lower abdominal surgery. While previous studies have examined this condition in specific surgical fields, comprehensive studies focusing on minimally invasive surgery, including laparoscopic and robot-assisted surgery, have not been conducted. This scoping review aimed to summarize the latest evidence on this condition, identify risk factors, and evaluate prevention strategies. Methods: This scoping review was conducted according to the PRISMA-ScR guidelines. A comprehensive literature search was performed using MEDLINE, Embase, and CENTRAL. Data were extracted from studies focusing on patients who underwent minimally invasive surgery in the lithotomy position. Results: A total of 25 studies, including cohort studies and case reports, were included. The majority of cases were observed in procedures exceeding 4 h in duration, with a notable prevalence in the left lower extremity during gastrointestinal surgical procedures. Fasciotomy was required in the majority of reported cases. Risk factors included high body mass index, large calf circumference, prolonged operative time, peripheral vascular disease, and specific surgical positions such as head-down or head-down plus right-sided tilting. Preventive measures included intraoperative lower limb pressure monitoring, leg positioning, use of improved support devices, and reduction of operative time in the lithotomy position. Conclusions: This review identified key risk factors and preventive measures for compartment syndrome of the unaffected lower limb in minimally invasive pelvic surgery. However, evidence for minimally invasive surgery is limited, and standardized guidelines do not exist. Further multicenter studies are needed to establish optimal preventive measures and improve patient safety. Full article

Background: The muscles and their tendons exhibit considerable morphological variations. While the anterior leg compartment may seem uniform, several well-documented variants of the tibialis anterior, extensor hallucis longus (EHL) and extensor digitorum longus (EDL) exist. In contrast, little is known about the fibularis tertius muscle (FT). This literature review aims to compile existing data on the FT and its variations and assess this structure’s clinical significance. Material and Methods: This comprehensive literature review is based on scientific articles obtained from PubMed. All relevant papers were included, and citation tracking was conducted to ensure a thorough examination of the topic. Results: This detailed literature review synthesizes the latest scientific findings regarding the FT, exploring its variable morphology, functional anatomy, evolutionary significance and clinical relevance. A high morphological variability of the FT is described including its origin, insertion and accessory form. Nevertheless, the FT has been described in cadaveric studies between adults and fetuses, while few classification systems have been proposed. Conclusions: The FT is an intriguing structure that has garnered interest from researchers across various fields, including medicine, clinical practice and biological sciences. There are few clinical implications of the muscle such as FT syndrome or tendon tear. Adequate knowledge of its anatomy is of paramount importance for clinicians. Full article

The development of compartment syndrome involving the lower limb is a potentially devastating complication of prolonged surgery in patients held in the lithotomy position. Well leg compartment syndrome (WLCS) was recognized in 1953. The incidence of this condition has been reported to range from 0.20% to 0.03%. The mechanism of WLCS development in the absence of trauma appears to be related to prolonged hypoperfusion of the limb, pressure on the muscle compartments, and in some cases, reperfusion of the ischemic limb. This grave complication develops either during or immediately after prolonged surgery in which the patient was held in the Lloyd-Davies lithotomy or hemi-lithotomy position. Surgeons must be aware of the potential for WLCS development during prolonged surgery. Signs of developing WLCS include swelling, increased firmness of the muscle compartments, discoloration, and cooling of the limb. Preventive measures can be taken without contaminating the surgical field by returning the limb to the right atrium level. Once the diagnosis has been made, failure to prevent the development of WLCS requires extensile fasciotomy of each leg compartment to restore perfusion and relieve elevated intra-compartment pressures. This article reviews the pathophysiology, prevention, and treatment of WLCS. Full article

Background: Position-related compressive nerve injury is a frequently reported complication of the lithotomy position. In contrast, compartment syndrome-induced neuropathy after lithotomy with prolonged surgery is rare and prone to misdiagnosis. This case describes the successful open decompression of sciatic neuropathy due to compartment syndrome after a prolonged lithotomy position. Case presentation: A 56-year-old male patient complained of an abnormal sensation in the lower leg and difficulty in dorsiflexion and plantarflexion of the left foot and toes after laparoscopic anterior hepatic sectionectomy for 16 h in a lithotomy position. Physical examination revealed severe pain and paresthesia below the distal left thigh. In manual muscle test grading, dorsiflexion and plantarflexion of the left ankle and toes were classified as grade 1. Computed tomography and magnetic resonance imaging showed ischemic changes in the mid-thigh posterior muscles, and the sciatic nerve was severely swollen at the distal thigh, which was compressed by the proximal edge of the well-leg holder. After debridement of the necrotic tissue and decompression of the sciatic nerve, the pain subsided immediately, and the ankle and toe dorsiflexion motor function improved to grade 4. Conclusions: Most case reports of compressive neuropathy associated with the lithotomy position have been related to conservative treatment. However, if a lesion compressing the nerve is confirmed in an imaging study and the correlation with the patient’s symptoms is evident, early surgical intervention can be an effective treatment method to minimize neurological deficits. Full article