Positioning Ideas: Lithotomy

We have a surgeon who likes us to use the bean bag. We put this on top of a green megadyne gel pad then use the regular yellow gel pad that fits on top of the bean bag. The U part where the patient's neck is positioned has the two parts on each side that we press up against the shoulders so when the patient is in a steep position they won't slide up towards head of bed. For patients we don't want sliding towards the bottom we use an axillary gel roll right under the buttocks. Hope this helps.

Here's an idea. If you can immobilize the thighs, the upper body won't be able to slip down. After the legs are in allen stirrups, I would wrap a folded blanket around each thigh for cushioning, so the thighs are like pigs in a blanket. Then tape the wrapped thighs to the stirrups so that the legs cannot extend during the case. Understand what I mean?

Good ideas, especially the bean bag. Thanks Issey and Linda. I can picture those helping.

Deb

We have a surgeon who likes us to use the bean bag. We put this on top of a green megadyne gel pad then use the regular yellow gel pad that fits on top of the bean bag. The U part where the patient's neck is positioned has the two parts on each side that we press up against the shoulders so when the patient is in a steep position they won't slide up towards head of bed. For patients we don't want sliding towards the bottom we use an axillary gel roll right under the buttocks. Hope this helps.

Oh they'll slide - not much that you can see - but if they wake up with nerve problems from having their shoulders compressed for 3 hours, you'll wish you had figured out a better way.

The egg crate concept works great.

Well that sounds concerning, if there's potential for nerve damage. So you suggest just using egg crate foam for making them "stay put"?

Deb

Oh they'll slide - not much that you can see - but if they wake up with nerve problems from having their shoulders compressed for 3 hours, you'll wish you had figured out a better way.

The egg crate concept works great.

That is a concern. Hasn't happened yet, thank God! But since you brought this up, i'm going to mention something next time. I would also like to know the egg crate concept.

Here's an idea. If you can immobilize the thighs, the upper body won't be able to slip down. After the legs are in allen stirrups, I would wrap a folded blanket around each thigh for cushioning, so the thighs are like pigs in a blanket. Then tape the wrapped thighs to the stirrups so that the legs cannot extend during the case. Understand what I mean?

Never seen anyone do that...interesting.

Here's another idea. Take 2 hip positioners shown below and clamp them to the head of the OR table so that the cushions touch the top of each shoulder. Make sure you put extra padding on them before doing so. This will keep the body from sliding without having to put anything under the patient. The pressure on the shoulders would be very little.

I don't know if this will work for you, but when one of our surgeon's does a Lap Nissen, he puts them in Lithotomy so he can stand between the legs. Anyhow, we do reverse trendelenburg with this procedure, and we use the allen bariatric thigh straps to keep them from sliding forward. I'm wondering if it will work for trendelenburg as well....

The pressure on the shoulders would be very little.

What gives you that idea? The weight of the patient is still pressing down on these shoulder pads, padded or otherwise. Doing this is a bad idea regardless. Again, the eggcrate works great.

What gives you that idea? The weight of the patient is still pressing down on these shoulder pads, padded or otherwise. Doing this is a bad idea regardless. Again, the eggcrate works great.

You're wrong. There is very little weight on the top of the shoulders. You act as if the patient is doing a headstand. It takes very little pressure to prevent a patient from sliding during trendelenburg. If there were a lot of weight, your eggcrate idea would not work. Furthermore, your eggcrate idea is unsafe because the patient can still slide if the angle is too steep

You're wrong. There is very little weight on the top of the shoulders. You act as if the patient is doing a headstand. It takes very little pressure to prevent a patient from sliding during trendelenburg. If there were a lot of weight, your eggcrate idea would not work. Furthermore, your eggcrate idea is unsafe because the patient can still slide if the angle is too steep

Apparently you don't do the types of cases we do. We use the eggcrate precisely because the patient is in max trendelenburg position, which approaches 45deg on our OR tables. The egg crate is secured to the table with wide adhesive tape. We don't use a sheet on top of the egg crate, and of course it is discarded after the procedure. The ridges in the eggcrate provide enough friction/resistance to keep the patient from sliding down the table. Leaving the patient on a regular table, putting something in place to block the shoulders, and then putting the patient in max trendelenburg WILL put significant pressure on the shoulders. If there were no cephalad force on the shoulders, there would be no reason to try the shoulder blocks as you have suggested, would there?

We use the same technique for some bariatric procedures and lap nissens as well to help keep them from sliding during steep reverse trendelenburg cases.