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Abstract 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. The interviews were semi‐structured and analysed by qualitative content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results The main theme showed that the OR nurses shoulder duty and responsibility, independently and in the team, but they need more structural support and knowledge. The themes showed that they follow routines whenever possible and take responsibility for positioning; however, they have to balance between flexibility and strict routines. Although they also develop and participate in teamwork, they still need further knowledge. Conclusion The severe complication of well leg compartment syndrome (WLCS) can occur when the patient is in the lithotomy position. Maintaining the same routines and paying attention to the WHO's surgical safety checklist were described as actions that could prevent well leg compartment syndrome. Patient or Public Contribution No patient or public contribution. We have interviewed nurses but without financial support since the study was performed and supervised within a master programme.

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. The interviews were semi‐structured and analysed by qualitative content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results: The main theme showed that the OR nurses shoulder duty and responsibility, independently and in the team, but they need more structural support and knowledge. The themes showed that they follow routines whenever possible and take responsibility for positioning; however, they have to balance between flexibility and strict routines. Although they also develop and participate in teamwork, they still need further knowledge. Conclusion: The severe complication of well leg compartment syndrome (WLCS) can occur when the patient is in the lithotomy position. Maintaining the same routines and paying attention to the WHO's surgical safety checklist were described as actions that could prevent well leg compartment syndrome. Patient or Public Contribution: No patient or public contribution. We have interviewed nurses but without financial support since the study was performed and supervised within a master programme. [ABSTRACT FROM AUTHOR]

Patients who underwent lower abdominopelvic surgeries in the lithotomy position (LP) and the Trendelenburg position (TP) with the leg holder are at risk of developing well leg compartment syndrome (WLCS). However, contributing factors related to the LP with TP associated with WLCS are unknown. This study aimed to investigate the associations between external pressure at the calf in the LPs at different angulations of the TP and physiological characteristics. Eighty-four university students (age, 21.7 ± 0.9; 42 men and 42 women) voluntarily participated in the study. The awake participants were placed in the LPs using the calf- and foot-supported leg holder at 0° (horizontal level), 5°, 10°, and 20° head-down tilts by moving the electric operating table. The peak contact pressure (pCP) was measured at the calf as a representative external pressure using the pressure distribution measurement system BIG-MAT®. Lower leg blood pressure significantly decreased with TP angulation, while calf pCP significantly increased with it at 0°, 5°, 10°, and 20° head-down tilts (39.4 ± 15.2, 46.5 ± 17.7, 47.2 ± 16.9, and 50.3 ± 17.6 mmHg, respectively). The calf pCP with a 10° head-down tilt was correlated positively with the calf total force (P < 0.001) and negatively with the calf contact area (P < 0.001). Blood hypoperfusion due to low lower leg blood pressure secondary to lower leg elevation and head-down tilt, and high calf external pressure due to direct external compression from the leg holder where it is loaded may contribute to WLCS. [ABSTRACT FROM AUTHOR]

The development of compartment syndrome involving the lower limb is a potentially devastating complication of prolonged surgery in patients held in the lithotomy position. Well leg compartment syndrome (WLCS) was recognized in 1953. The incidence of this condition has been reported to range from 0.20% to 0.03%. The mechanism of WLCS development in the absence of trauma appears to be related to prolonged hypoperfusion of the limb, pressure on the muscle compartments, and in some cases, reperfusion of the ischemic limb. This grave complication develops either during or immediately after prolonged surgery in which the patient was held in the Lloyd-Davies lithotomy or hemi-lithotomy position. Surgeons must be aware of the potential for WLCS development during prolonged surgery. Signs of developing WLCS include swelling, increased firmness of the muscle compartments, discoloration, and cooling of the limb. Preventive measures can be taken without contaminating the surgical field by returning the limb to the right atrium level. Once the diagnosis has been made, failure to prevent the development of WLCS requires extensile fasciotomy of each leg compartment to restore perfusion and relieve elevated intra-compartment pressures. This article reviews the pathophysiology, prevention, and treatment of WLCS. [ABSTRACT FROM AUTHOR]

Abstract Background The indications for robot-assisted urologic surgeries have expanded due to their low invasiveness. However, complicated surgical procedures lead to prolonged surgical duration, requiring patients to remain in the lithotomy position for an extended time. Well leg compartment syndrome (WLCS) is a known severe postoperative complication related to the lithotomy position. Case presentation We report a case of WLCS after robot-assisted radical cystectomy (RARC), in which the patient recovered without neurological sequelae. A 55-year-old, obese male who underwent RARC complained of right leg pain and paresthesia 3 h after the surgery that lasted for 481 min. Emergency evaluation revealed unilateral WLCS in the anterior and lateral compartments. Urgent fasciotomy was performed 4 h after symptom onset. He thereafter recovered completely and was discharged without any neuromuscular dysfunction. Conclusions Early detection of WLCS, surgical treatment, and additional measures are crucial to prevent its life-threatening and/or disabling outcomes.

Introduction: Well leg compartment syndrome is a rare postoperative condition that occurs as a result of non-traumatic ischemic insult. It has similar pathophysiology to compartment syndrome; however, no definitive etiology is identified. Several risk factors such as patient position, leg position, young age, and high BMI for the development of this condition are considered. Case report: A 30 years old male smoker and overweight, underwent mandibular and maxillary osteotomies in reverse Trendelenburg position. He developed a WLCS post-operative and treated with fasciotomy. Conclusion: Increased Awareness of this rare occurrence and predisposition aids in understanding and prompt management. This article provides a rare case that has occurred in reverse Trendelenburg position with less obvious risk factors than typically reported in the literature [ABSTRACT FROM AUTHOR]

Iris F Brouze, Sylvain Steinmetz, John McManus, Olivier BorensService of Orthopaedic surgery and Traumatology, CHUV – University Hospital Vaud, Lausanne, SwitzerlandAbstract: Well leg compartment syndrome (WLCS) is a rare complication which can occur following urological, gynecological, general surgical or orthopaedic surgeries carried out with the lower limb in the hemilithotomy position. WLCS is associated with significant morbidity and mortality because delay in diagnosis and treatment can lead to loss of function and even life-threatening complications. During orthopaedic surgeries on a traction table, such as femoral nailing, the contralateral “well leg” is often placed in the hemilithotomy position, thus facilitating the use of fluoroscopy. This position (also named the Lloyd-Davis position) consists of hip flexion, abduction, external rotation and knee flexion. We present the cases of two teenaged patients who underwent femoral nailing on an extension table of a femoral fracture and developed WLCS. We also present a review of the literature and a discussion of the pathophysiology, risk factors and treatment of this condition. Clinicians need to be aware of the risk factors for WLCS and have high index of suspicion. Further studies looking at the risks, benefits and feasibility of ways to reduce this risk are required.Keywords: WLCS, well leg compartment syndrome, femoral shaft fracture, intramedullary nailing, hemilithotomy position, case series

Background: The indications for robot-assisted urologic surgeries have expanded due to their low invasiveness. However, complicated surgical procedures lead to prolonged surgical duration, requiring patients to remain in the lithotomy position for an extended time. Well leg compartment syndrome (WLCS) is a known severe postoperative complication related to the lithotomy position. Case presentation: We report a case of WLCS after robot-assisted radical cystectomy (RARC), in which the patient recovered without neurological sequelae. A 55-year-old, obese male who underwent RARC complained of right leg pain and paresthesia 3 h after the surgery that lasted for 481 min. Emergency evaluation revealed unilateral WLCS in the anterior and lateral compartments. Urgent fasciotomy was performed 4 h after symptom onset. He thereafter recovered completely and was discharged without any neuromuscular dysfunction. Conclusions: Early detection of WLCS, surgical treatment, and additional measures are crucial to prevent its life-threatening and/or disabling outcomes. [ABSTRACT FROM AUTHOR]

Robot-assisted laparoscopic prostatectomy (RALP) for prostate cancer was introduced in 2000 and rapidly gained popularity. The Da Vinci Surgical System® can ensure improved local control of cancer and fewer perioperative complications. However, RALP is performed in the steep-Trendelenburg position (a combination of lithotomy and head-down tilt position / Lloyd-Davies position) to obtain a good surgical view, and as a result, well leg compartment syndrome (WLCS) can become a serious complication of RALP. Here, we report a case of WLCS after RALP. A 75-year-old man underwent surgery for prostate cancer and immediately complained of pain and numbness after surgery. The pressure of the four leg compartments increased. Ultimately, we diagnosed the patient with WLCS in his right leg, and an emergency fasciotomy was performed. He completely recovered with no permanent disability and was discharged one month after rehabilitation. Although WLCS after RALP is a rare and severe complication, the patient recovered completely with early diagnosis and intervention. Measuring the compartment pressure is useful when the patient is drowsy immediately after recovery from anesthesia. Preventing WLCS requires identifying this condition as a potential complication of RALP and all urologic surgeries performed in the lithotomy position. [ABSTRACT FROM AUTHOR]

Well leg compartment syndrome refers to the occurrence of compartment syndrome in an uninjured limb in the absence of an underlying systemic predisposing cause. It is a rare phenomenon with devastating clinical consequences resulting from commonly utilized operative positions and requires a high index of suspicion for diagnoses. There are only a few reports in the literature and a lack of awareness of the condition. Identifying patients with at risk predisposition and increasing surveillance in these patients may allow for early detection and decrease the morbidity and potential mortality associated with well-leg compartment syndrome.

Lower limb compartment syndrome caused by improper positioning during surgery is called well-leg compartment syndrome. Although well-leg compartment syndrome has been reported in urological and gynecological patients, there have been no reports of well-leg compartment syndrome in patients who have undergone robot-assisted surgery for rectal cancer. A 51-year-old man was diagnosed with lower limb compartment syndrome by an orthopedic surgeon due to pain in both of his lower legs immediately following robot-assisted surgery for rectal cancer. Due to this, we started placing the patient in the supine position during these surgeries, and repositioned the patient to the lithotomy position following intestinal tract cleansing after rectal movement in the latter half of the surgery. This avoided the long-term effects of being in the lithotomy position. We compared the operation time and complications before and after the above measures were changed, in 40 cases of robot-assisted anterior rectal resection for rectal cancer performed at our hospital from 2019 to 2022. We found no extension of operation time and no occurrence of lower limb compartment syndrome. There have been several reports describing the risk reduction of WLCS using intraoperative postural changes. An intraoperative postural change from a natural supine position without pressure which we reported is considered to be a simple preventive method for WLCS. Changing the patient from the supine position to the lithotomy position during surgery may be a clinically acceptable countermeasure to prevent lower limb compartment syndrome. • A man who was diagnosed with leg compartment syndrome after robotic rectal cancer surgery • Changing the patient from the supine position to the lithotomy position during surgery • Short term outcome in 40 cases of robot-assisted anterior rectal resection for rectal cancer [ABSTRACT FROM AUTHOR]

Introduction Well leg compartment syndrome (WLCS) is an uncommon and severe complication that occurs after colorectal surgery in the lithotomy position. Presentation of case The current patient was a 28-year-old male suffering from ulcerative colitis. He was underwent elective proctectomy, including ileal J pouch formation and anal anastomosis with temporary loop ileostomy. The ileoanal pouch procedure was quite difficult, and during this procedure, the high lithotomy and head down tilt positions were continued for 255 min. After the operation, the patient complained of severe cramping pain, swelling and serious tenderness on palpation in both legs. On the first postoperative day, the patient's complaints gradually worsened. The intra-compartmental pressure was measured, and WLCS was diagnosed. Emergency bilateral fasciotomy was performed. Initially, the patient had a sensory deficit and analgesia, however, his sensory disturbance and pain had almost recovered two months after fasciotomy by rehabilitation. Discussion In the current case, the important factors associated with the development of WLCS are thought to be a prolonged operative time in which the patient is placed in the high lithotomy position during ileoanal pouch procedure. Conclusion We would thus like to emphasize that operations for the ileoanal pouch procedure to treat ulcerative colitis have a high potential for inducing WLCS, because it usually requires a prolonged operative time in which the patient remains in the high lithotomy position. [ABSTRACT FROM AUTHOR]

Robot-assisted laparoscopic prostatectomy (RALP) for prostate cancer was introduced in 2000 and rapidly gained popularity. The Da Vinci Surgical System? can ensure improved local control of cancer and fewer perioperative complications. However, RALP is performed in the steep-Trendelenburg position (a combination of lithotomy and head-down tilt position/Lloyd-Davies position) to obtain a good surgical view, and as a result, well leg compartment syndrome (WLCS) can become a serious complication of RALP. Here, we report a case of WLCS after RALP. A 75-year-old man underwent surgery for prostate cancer and immediately complained of pain and numbness after surgery. The pressure of the four leg compartments increased. Ultimately, we diagnosed the patient with WLCS in his right leg, and an emergency fasciotomy was performed. He completely recovered with no permanent disability and was discharged one month after rehabilitation. Although WLCS after RALP is a rare and severe complication, the patient recovered completely with early diagnosis and intervention. Measuring the compartment pressure is useful when the patient is drowsy immediately after recovery from anesthesia. Preventing WLCS requires identifying this condition as a potential complication of RALP and all urologic surgeries performed in the lithotomy position. J. Med. Invest. 69 : 145-147, February, 2022.