We report a case of well leg compartment syndrome (WLCS) in both legs after robot-assisted laparoscopic prostatectomy (RALP). A 65-year-old man underwent surgery for prostate cancer. He was placed in the lithotomy position and both his legs were protected with elastic stockings and intermittent pneumatic com- pression to prevent deep vein thrombosis during sur- gery. After surgery, he complained of pain in both calves. Movement and sensory disorder along with swelling were found in both legs. Computed tomogra- phy of the legs showed damage to the soleus and gas- trocnemius muscles of both legs. The creatinine phos- phokinase level had increased to 10,560 IU · l⁻¹. The patient was diagnosed with WLCS in both legs and underwent conservative treatment. Symptoms in both legs started to improve from the next day. The right leg swelling receded within 10 days, while the left leg swelling receded 67 days after surgery. WLCS in the legs after RALP is a rare but severe complication requiring early diagnosis and intervention. To prevent WLCS, it is important that we recognize this disease as a potential complication after RALP.

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Article Synopsis
  • - Well-leg compartment syndrome (WLCS) is a rare but serious condition that can arise from specific surgical positions, with a 1 in 3500 incidence during lithotomy, necessitating attention to prevention and diagnosis due to potential complications.
  • - A study involving 178 patients examined postoperative serum creatine kinase (CK) levels, comparing those with elevated CK levels (≥250) to those without (under 250), to identify risk factors related to colorectal cancer surgeries performed in the lithotomy-Trendelenburg position.
  • - The study found that elevated CK levels were linked to male gender, rectal surgeries, prolonged head-down positioning (≥180 minutes), and larger preoperative calf circumferences, underscoring the importance of monitoring
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Background The aim of this study was to determine the incidence of deep tissue injury (DTI) and potential risk factors after surgery in the lithotomy position. Methods All patients who underwent surgery in the lithotomy position under general anesthesia at a single center between January 2017 and December 2021 were retrospectively evaluated. The medical records of these patients were reviewed, and patient demographic and clinical characteristics, surgical data, and occurrence of DTI were recorded.

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Well-leg compartment syndrome after laparoscopic low anterior resection in the lithotomy position: a case report and literature review.

J Surg Case Rep

April 2024

Faculty of Medicine, Department of Digestive and General Surgery, Shimane University, 89-1, Enya-cho, Izumo City, Shimane 693-8501, Japan.

Well-leg compartment syndrome (WLCS) develops in healthy lower limbs because of surgical factors such as operative position, lower limb compression, and long operative time during abdominopelvic surgery. WLCS can lead to irreversible muscle and nerve damage if a prompt diagnosis and appropriate treatment are not provided. We report the case of a 57-year-old male who developed rectal cancer immediately after laparoscopic low anterior resection and was successfully treated with fasciotomy without sequelae.

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Article Synopsis
  • - The study investigated how new lithotomy stirrups (type 2) affect pressure distribution on lower limbs during laparoscopic and robot-assisted rectal surgery, aiming to minimize the risk of well-leg compartment syndrome (WLCS) and deep venous thrombosis (DVT).
  • - Researchers tested 30 participants by measuring pressure on different leg muscles in various positions using both conventional stirrups (type 1) and the new stirrups (type 2) with a specialized sensor.
  • - Results showed that the new stirrups significantly reduced pressure on key leg muscles, particularly shifting from the proximal to the more distal soleus muscle, which may lower the likelihood of WLCS and DVT after surgery; however
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Aim: To describe operating room nurses' experiences of well leg compartment syndrome and how they work perioperative to prevent it during the lithotomy position.

Design: The study had a qualitative design.

Methods: Focus group interviews were performed with 10 operating room (OR) nurses.

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