Lower limb compartment syndrome as a complication of laparoscopic laser surgery for severe endometriosis

OBJECTIVE: To report a case of lower limb compartment syndrome (LLCS) during long duration laparoscopic interventions for resection of extensive endometriosis, and evaluate the efficiency of a novel patient positioning method to reduce its prevalence. DESIGN: Case report and observational study. SETTING: University Hospitals, Belgium. PATIENT(S): Thirty-year-old woman undergoing a long duration laparoscopic intervention for resection of stage IV pelvic endometriosis. INTERVENTION(S): Laparoscopic intervention for resection of stage IV pelvic endometriosis. MAIN OUTCOME MEASURE(S): The occurrence of LLCS after laparoscopic surgery for extensive endometriosis, in this case, and the prevention of subsequent LLCS after the application of a novel patient positioning method including the following steps: maximal avoidance of the lithotomy position, patient positioning in a modified supine position, mobilization of the legs of the patient in between different surgical phases, and application of intermittent compression stockings. RESULT(S): The prevalence of lower limb compartment syndrome has been reduced to 0 since the application of the new patient positioning method. CONCLUSION(S): Lower limb compartment syndrome can be prevented in patients undergoing long duration multidisciplinary laparoscopic resection of extensive endometriosis by a novel sequential positioning method of patients before and during surgery.