Risk Factors and Preventive Measures for Well-Leg Compartment Syndrome During Minimally Invasive Surgery in the Lithotomy Position

Background/Objectives: Well-leg compartment syndrome is a rare but potentially life-threatening complication associated with the lithotomy position during pelvic or lower abdominal surgery. While previous studies have examined this condition in specific surgical fields, comprehensive studies focusing on minimally invasive surgery, including laparoscopic and robot-assisted surgery, have not been conducted. This scoping review aimed to summarize the latest evidence on this condition, identify risk factors, and evaluate prevention strategies. Methods: This scoping review was conducted according to the PRISMA-ScR guidelines. A comprehensive literature search was performed using MEDLINE, Embase, and CENTRAL. Data were extracted from studies focusing on patients who underwent minimally invasive surgery in the lithotomy position. Results: A total of 25 studies, including cohort studies and case reports, were included. The majority of cases were observed in procedures exceeding 4 h in duration, with a notable prevalence in the left lower extremity during gastrointestinal surgical procedures. Fasciotomy was required in the majority of reported cases. Risk factors included high body mass index, large calf circumference, prolonged operative time, peripheral vascular disease, and specific surgical positions such as head-down or head-down plus right-sided tilting. Preventive measures included intraoperative lower limb pressure monitoring, leg positioning, use of improved support devices, and reduction of operative time in the lithotomy position. Conclusions: This review identified key risk factors and preventive measures for compartment syndrome of the unaffected lower limb in minimally invasive pelvic surgery. However, evidence for minimally invasive surgery is limited, and standardized guidelines do not exist. Further multicenter studies are needed to establish optimal preventive measures and improve patient safety.