Different patient positions are required during robotic surgery including supine, Trendelenburg, lithotomy, and lateral flank positions. However, each surgical position has its own implications for circulation, ventilation, and hemodynamics and may possibly expose patients to morbid adverse events particularly peripheral nerve and pressure-related injuries, including sciatic nerve injury, paresthesia, numbness, rhabdomyolysis of the thigh, and compartment syndrome. These positioning injuries are rare in robotic urological procedures but may be serious enough to cause severe morbidity. Therefore, it is crucial to consider the complications unique to different positions to avoid or minimize these possible risks and maintain patient safety. Exaggerated intraoperative lateral or Trendelenburg positions, prolonged operative time, male gender, high preoperative American Society of Anesthesiologists class, and increased body mass index, especially with large muscle mass, are well-documented risk factors for these positioning injuries. Therefore, thorough perioperative assessment and careful attention to appropriate patient positioning is crucial while considering the different risk factors which may predispose and aggravate these complications, especially in prolonged procedures and/or when extreme positioning is used.
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