Development of Evidence-based Clinical Practice Guidelines for the Prevention of Peripheral Neurological Injury During Robotic-assisted Prostatectomies for Patients in the Steep Trendelenburg Position

Tyler Wolpert


Robotic-assisted surgery (RAS) is becoming more prevalent in modern surgical practice and is currently being utilized in a range of surgical specialties from colorectal and gynecological procedures to bariatrics and orthopedics. Every surgical procedure has potential risk to patients, however robotic-assisted laparoscopic prostatectomies (RALP) in the steep Trendelenburg (ST) position poses unique risk for peripheral nerve injury (PNI). Despite attempts to reduce the incidence rate of PNI during RALP, injuries are still occurring to patients causing patient harm and anesthesia provider litigation. The implementation of a CRNA based safety checklist may reduce the incidence rate of PNI and provider litigation for these procedures. The overall purpose of this quality improvement project is to reduce the risk of PNI to patients undergoing anesthesia during RALP. The primary aim of the project is to create, implement, and evaluate the effects an evidence-based clinical practice safety checklist for use in conjunction with the surgical timeouts will have on the incidence rate of PNI. The following objectives have been established to achieve the aim of this project: 1) create and incorporate a practice safety checklist for CRNAs to use during surgical timeouts, using best practice evidence from the literature, 2) compare pre-and post-implementation outcome findings using clinical observations audits and lastly 3) provide project findings, identified barriers, and recommendations for sustainment and continued monitoring, using a SWOT analysis briefing and discussion format to the key stakeholders.