Efficacy of controlling external pressure on the lower leg during surgical positioning on preventing rhabdomyolysis and well leg compartment syndrome after robot-assisted radical prostatectomy

Purpose Position-related complications of robot-assisted radical prostatectomy (RARP) include rhabdomyolysis and well leg compartment syndrome (WLCS). This study aimed to explore a method for preventing rhabdomyolysis and WLCS, focusing on external pressure on the lower leg during surgery. Methods Three hundred patients who underwent RARP performed in the steep Trendelenburg position with a 25-degree head-down tilt between June 2018 and June 2022 were examined. The patients were divided into pressure-controlled and non-pressure-controlled groups. In the pressure-controlled group, external pressure on the lower leg was measured using the Portable Interface Pressure Sensor (Palm Q®) while creating the surgical position. The patient was placed in the required surgical position ensuring that external pressure on the lower leg was maintained below 20 mmHg. In the non-pressure-controlled group, external pressure on the lower leg was not measured. Postoperative outcomes, including creatine kinase (CK) levels and incidence of rhabdomyolysis and WLCS were compared. Results CK levels on postoperative days (POD) 1 and 2 were significantly lower in the pressure-controlled group (median: 342 and 352 IU/L, respectively) than in the non-pressure-controlled group (837 and 708 IU/L, respectively) (p < 0.05 for both comparisons). The incidence of rhabdomyolysis was lower in the pressure-controlled group, and no cases of WLCS were observed, in contrast to two cases identified in the non-pressure-controlled group. Conclusions Maintaining external pressure on the lower legs below 20 mmHg during RARP may contribute to preventing rhabdomyolysis and WLCS after RARP. This method can be applicable to other surgeries performed in the Trendelenburg position.