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Learning Objective 1: The learner will be able to describe the steps in reducing pressure ulcers acquired intraoperatively in surgical patients.
Learning Objective 2: The learner will be able to discuss intraoperative positioning and safety concerned with utilization of the robot during surgical cases.
Long Duration Robotic Surgery
Purpose: The purpose of this project was to improve patients post operative skin condition undergoing long duration robotic surgery. In Robotic Surgeries exceeding 3 hours, will releasing each shoulder bolster for 5-10 minutes every 2-3 hours result in improved post-operative skin integrity?
Background: In 2009, an increase in shoulder Stage 1-3 pressure ulcers (PU) was observed postoperatively in robotic surgical patients in steep Trendelenburg position for 3 hours or greater. Temporary relief of shoulder bolster pressure was proposed to prevent skin injury.
Methods: One shoulder bolster was released for 5-10 minutes every 3 hours. The other shoulder bolster was not released. None of the released sites developed a PU while all of the non-released assessed as stage 1-2 PU at case conclusion. Due to favorable results, consultation occurred with Ethics and Risk Management. The method of acquiring data was modified and shoulder bolsters were released bilaterally.
Results: In 4 robotic cases, the non released shoulder revealed Stage 1-2 PU development while no damage was noted on the non released shoulder. Seven cases with bilateral release showed no PU development. PU assessment form for 556 surgical cases indicated 26 possible PUs. All but 5 instances subsided without PU development and none were robotic.
Discussion: Improved post operative skin condition was achieved through the release of bolsters. Limitations include small sample size and an unexpected ethical dilemma. Increased awareness of perioperative skin condition and improved interdepartmental communication occurred as a result of staff education and assessment form.
Conclusion: Release of bolsters does improve postoperative skin integrity in long duration robotic surgeries. Based on these preliminary results, intermittent pressure release should ethically become a standard practice for all patients.
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