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Case Reports
. 2021 Sep 20:10:534-537.
doi: 10.1016/j.xjtc.2021.09.028. eCollection 2021 Dec.

Upper rectus abdominis paralysis after robot-assisted thoracic oncology surgery with cryoanalgesia: A rare complication

Davina Wildemeersch  1 , Suresh Krishan Yogeswaran  2 , Guido Vyncke  3 , Ine Meeus  1 , Tim Wielandt  3 , Guy Hans  1 , Eric Vanduynhoven  1
Affiliations
Case Reports

Upper rectus abdominis paralysis after robot-assisted thoracic oncology surgery with cryoanalgesia: A rare complication

Davina Wildemeersch et al. JTCVS Tech. .
No abstract available

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Figures

None
Abdominal wall muscles and rectus abdominis muscle innervation.
Figure 1
Figure 1
Patient installation and port placement. For the robot-assisted thoracoscopic surgery, 4 ports are used. These were placed in the sixth intercostal space, over the top of the seventh rib. There is 1 assisting port (blue cross), this is placed 1 intercostal space below the other ports, just over the top of the eighth rib. The camera port is marked with a red circle. Port characteristics: 8 mm infrascapular port, 12 mm port, assisting port (blue cross), 8 mm camera port, 12 mm port.
Figure 2
Figure 2
A, Patient 4 months after surgery. Abdominal swelling due to paralysis of the upper part of the rectus abdominal muscle and superior oblique at the level of dermatome Th6 through Th9. B, Patient 1 year after surgery. Persistent swelling is seen. Note: The reduced hair growth at the right abdominal side is due to shaving for physiotherapeutic reasons.
Figure 3
Figure 3
Computed tomography axial section of the lumbar spine at the level of Th12 for analysis of muscle density on the 2 sides. The atrophied right side of the rectus muscle became less dense as measurement in Hounsfield units (HU). A, Muscle thickness 0.52 versus 1.20 cm. B, Density measurement 29 versus 66 HU.
Figure 4
Figure 4
Overview of rectus abdominis muscle and nerve supply. The rectus abdominis muscle is a paired muscle running vertically on each side of the anterior abdominal wall, separated by the linea alba. It extends from pubis symphysis to the xiphoid process and costal cartilages of ribs 5 to 7. The rectus has many sources of arterial blood supply, including branches of superior and inferior epigastric arteries, and numerous contributions from intercostal arteries. The innervation is provided by thoracoabdominal nerves (yellow), which are continuations of lateral and anterior branches of Th7 through Th12 intercostal nerves. Before entering the lateral side of the rectus sheath, this small nerve travels between the transverse abdominis muscle and the middle layer; that is, the internal oblique muscle. Robotic port sites are illustrated as black crosses.
See this image and copyright information in PMC

Comment in

  • Commentary: Battle of the bulge.
    Mitzman B. Mitzman B. JTCVS Tech. 2021 Oct 24;10:538-539. doi: 10.1016/j.xjtc.2021.10.026. eCollection 2021 Dec. JTCVS Tech. 2021. PMID: 34984400 Free PMC article. No abstract available.
  • Commentary: Did you leave a ball inside me?
    Demmy TL. Demmy TL. JTCVS Tech. 2021 Oct 9;10:540-541. doi: 10.1016/j.xjtc.2021.10.004. eCollection 2021 Dec. JTCVS Tech. 2021. PMID: 34984401 Free PMC article. No abstract available.

References

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