Digital nerve compression due to laparoscopic surgery

SurgEndosc (1995) 9:740

Surgical Endoscopy © Spiinger-Verlag New York Inc. 1995

Digital nerve compression due to laparoscopic surgery Indications for laparoscopic surgery seem to extend daily. More complex operations become feasible for laparoscopy. Entanglement of instruments demands a spatial placement of the trocars resulting in an ergonomically suboptimal working position for the surgeon. In children entanglement of instruments is an even greater problem with less working space. The handling of instruments can be strenuous because of the straightness of the instruments and sometimes the sharp edges. Recently two members of a surgical team that performs many laparoscopic procedures suffered from digital nerve compression of the thumb after prolonged procedures. The proper palmar digital nerves run alongside the flexor poUicis longus tendon. The dorsal digital branches of the radial nerve parallel to the extensor pollicis longus tendon. Due to the instrumentation with the arms in abduction the force exerted

by the four fingers has to be counteracted by a force of the thumb which is transverse on the digital axis. In this position either one of the digital nerves is easily compressed. Restoration of sensibility was complete in the first case. The second surgeon still has a neuropraxis 2 months after the event. We plea for the development of ergonomically more responsible equipment--preferably interchangable instruments.

D. C. van der Zee N. M. A. Bax Department of Pediatric Surgery Wilhelmina University Children's Hospital P.O. Box 18009 3501 CA, Utrecht The Netherlands