Lower Extremity Injury While Undergoing Urology Procedures in the Trendelenburg with Lithotomy Position: Three Case Reports

Greta M. Vladinov, Betty Glick, Henry O. Aguirre, Robert S. Fiala, Joni M. Maga

Research output: Contribution to journalArticlepeer-review


Purpose: To report and discuss the incidence of severe lower extremity injuries associated with robotic procedures in Trendelenburg with lithotomy position. Design and Methods: A case study method was used to describe three cases of patients who underwent robotically assisted urological procedures in Trendelenburg with lithotomy position and developed serious lower extremities injuries resulting in fasciotomies. Furthermore, a literature review was conducted to evaluate risk factors and possible interventions for the prevention of similar injuries. Findings: Case analysis revealed multifactorial causes, including patient comorbidities, long surgical procedures, and blood pressure decreases below the baseline for more than 30 minutes. The severity of lower extremity injury associated with lithotomy position may be underestimated. The etiology of peripheral nerve injury can be attributed to patient comorbidities, positioning, and surgical conditions. Injury prevention should include careful patient and procedural risk assessment, staff education, and communication strategies. Conclusions: Extreme Trendelenburg with lithotomy position for longer periods can lead to serious lower extremities injuries. Preanesthetic screening and multidisciplinary team discussions for additional precautions for high-risk patients are crucial interventions to decrease incidence and severity of lower extremities injuries.

Original languageEnglish (US)
Pages (from-to)214-218
Number of pages5
JournalJournal of Perianesthesia Nursing
Issue number3
StatePublished - Jun 2021


  • lower extremities injuries in lithotomy position
  • Trendelenburg position complications
  • urological surgery complications

ASJC Scopus subject areas

  • Medical–Surgical


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