Which measure helps reduce the risk of nerve injury during laparoscopy?

• A. Increase patient positioning pressure
• B. Prolonged Trendelenburg position
• C. Careful positioning and padding
• D. High-pressure pneumoperitoneum

Answer: (C)

Protecting nerves during laparoscopy comes from avoiding sustained compression and traction, which are most effectively prevented by careful positioning and padding. Nerve injuries often result when limbs are placed in positions that stretch or compress nerves (such as excessive abduction, rotation, or bending at joints) or when pressure points are not well cushioned. Using neutral joint alignment, avoiding extreme flexion or extension, and placing well-fitted padding under pressure points (heels, ankles, knees, hips, elbows, shoulders, head) distributes weight and reduces focal pressure, decreasing the risk of neuropraxia during the procedure. Regularly reassessing position during longer operations and minimizing time in risky positions further protects the nerves.

Other measures don’t directly address the mechanism of nerve injury. Increasing pressures on the body isn’t protective and can introduce other risks; prolonged Trendelenburg can worsen nerve stretch and perfusion issues; high-pressure pneumoperitoneum affects physiology more than nerve protection.