Article Text

Download PDFPDF
Prolonged brachial plexus neuropathy: a rare complication following protracted endometriosis surgery in Lloyd-Davies position
  1. Anna Katrina Hay1,
  2. Anna McDougall1,
  3. Peter Hinstridge1,
  4. Sanjeev Rajakuldendran2 and
  5. Wai Yoong1
  1. 1Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, UK
  2. 2Neurology, North Middlesex University Hospital NHS Trust, London, UK
  1. Correspondence to Dr Anna Katrina Hay; anna.hay2{at}


Brachial plexus injury is a rare but potentially serious complication of laparoscopic surgery. Loss of motor and/or sensory innervation can have a significant impact on the patient’s quality of life following otherwise successful surgery. A 38-year-old underwent elective laparoscopic management of severe endometriosis during which she was placed in steep head-down tilt Lloyd-Davies position for a prolonged period. On awakening from anaesthesia, the patient had no sensation or movement of her dominant right arm. A total plexus brachialis injury was suspected. As advised by a neurologist, an MRI brachial plexus, nerve conduction study and electromyography were requested. She was managed conservatively and made a gradual recovery with a degree of residual musculocutaneous nerve neuropathy. The incidence of brachial plexus injury following laparoscopy is unknown but the brachial plexus is particularly susceptible to injury as a result of patient positioning and prolonged operative time. Patient positioning in relation to applied clinical anatomy is explored and risk reduction strategies described.

  • anaesthesia
  • pain
  • peripheral nerve disease
  • obstetrics and gynaecology
  • surgery

Statistics from


  • Contributors AKH and AM wrote the case report. PH and SR gave feedback, advice and edited the case report. WY supervised and edited the case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.