Positioning during radical retropubic prostatectomy

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Do you guys usually place the safety strap just above the knees, or at mid-calf?

Do you spread (and leave) the legs slightly apart, like a "V", as you might when you do a fem-pop, (so that you can access the groin prn) or do you leave them in straight adduction, as you would any other routine supine position abdominal surgery (i.e., chole?

Do you put anything under the coccyx for slight elevation, such as a gel roll or IV bag?

Do you use TEDS and SCDs intraop, or does it vary according to surgeon's preference?

I am seeing so many variations lately depending to institution that I am starting to wonder why......that is, the rationale of the various differences, or if there is any other than the idiosyncracies of the various urologists involved...

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Also depends on anesthesia's preference for positioning. Routinely seeing epidural catheters placed before hand. Sometimes actually slightly Jack-knife the table or elevate the kidney rest part.

TEDS and SCDs almost always...........actually every case that I have done.

Legs are usually together but just enough apart so that you can easily get the foley changed out during the case. Usually need access just very anteriorly..........

Hope that this helps............ :)

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Also depends on anesthesia's preference for positioning. Routinely seeing epidural catheters placed before hand. Sometimes actually slightly Jack-knife the table or elevate the kidney rest part.

TEDS and SCDs almost always...........actually every case that I have done.

Legs are usually together but just enough apart so that you can easily get the foley changed out during the case. Usually need access just very anteriorly..........

Hope that this helps............ :)

Yeah, I personally think that TEDs/SCDs should be a nursing decision--I always put them on for any case I anticipate will take more than 2 hours, or any high risk patients, especially those who haven't been Heparinized pre-op. I've never had a surgeon argue--it's other NURSES who seem to think they need an order. I guess on the floors they might, but the surgeons I am used to working with trust us--depend on us--to make independent nursing decisions about optimal patient care.

So, where do you place the safety strap? Typically mid-thigh, just above the knees, or mid-calf? I am thinking mid-thigh should not interfere with exposure, and one shouldn't really need a strap at the mid-calf level unless the legs are abducted so far as to risk them falling off the table at the ankle.....

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Mid-thigh is just fine.........it will still hold them on the table. Calf is totally useless as a safety strap, unless it is a second strap in my opinion. How would it keep anyone on a table? I would rather use another area than ut a safety strap at mid-calf. How can it actually be a safety strap?

I do not wait for the two hour rule for the SCDs, etc. Any patient that is in stirrups, other than for a quick D and C, should also have them.

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Mid-thigh is just fine.........it will still hold them on the table. Calf is totally useless as a safety strap, unless it is a second strap in my opinion. How would it keep anyone on a table? I would rather use another area than ut a safety strap at mid-calf. How can it actually be a safety strap?

I do not wait for the two hour rule for the SCDs, etc. Any patient that is in stirrups, other than for a quick D and C, should also have them.

Thanks, Suzanne, for your excellent input.

I agree; using TEDs and SCDs for patients in lithotomy is a given.

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Specializes in surgical, emergency.

For protatectomy's, thigh strap, legs sl. spread, but we include the member/scrotum into the prep and drape. When I'm done prepping, I hold up the scrotum, and the tech lays a sterile towel underneath, and we rest it on that. A basic 4 towel drape, then our paper drapes, that way the doc can put the foley in himself.

I put the hips at the break in the table, and we reverse flex them.

I also use a lot of gel pads under arms, heels, etc.

Ted's are great also SCD's. That usually depends on the doc.

The GYN guys usually do 5000 of SQ heparin pre op as well as the TED'S.

I like gel pads, they come in real hand at times.

Mike

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For our open prostates, we usually put the strap mid thigh and have the bed flexed. And we do have our patients wear TEDS and SCDs for the OR. We prep the member and scrotum into the field so they can put a Foley in intra-op.

How is your positioning for open prostates different from lap prostates?

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For our open prostates, we usually put the strap mid thigh and have the bed flexed. And we do have our patients wear TEDS and SCDs for the OR. We prep the member and scrotum into the field so they can put a Foley in intra-op.

How is your positioning for open prostates different from lap prostates?

Huh, I've never even SEEN a lap prostate! I hate laparoscopic cases--try to avoid those rooms at all costs. Except for laparoscopic duodenal switch procedures and laparoscopic Roux-en-Ys (both for morbid obesity.) Now, those are fun.

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Huh, I've never even SEEN a lap prostate! I hate laparoscopic cases--try to avoid those rooms at all costs. Except for laparoscopic duodenal switch procedures and laparoscopic Roux-en-Ys (both for morbid obesity.) Now, those are fun.

You should, I didn't know lap prostates were possible either until I started working at my current workplace. I enjoy laparoscopic cases, I used to do them all the time until this year when they started putting me in neuro. Now I'm lucky if I get one lap case in a week. I like doing lap prostates, the surgeon who does them where I work is my favorite MD to work with for sure. Now, I've heard of the duodenal switch procedure....what's it like circulating those? We're just do the lap and open Roux en Ys and Lap bands in terms of bariatrics and they are work. I'm sweating by the time I'm done plugging stuff in, turning them on and setting up the iron intern retractor.

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we do lap prostatectomies with the davinci robot, though i've never scrubbed one yet. they have a specialized team for these cases. frankly, i've never seen an open prostatectomy! odd, eh? this tends to peeve the urology residents since this is a procedure they must know...and we so rarely do them.

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Specializes in O.R Trauma Nurse.

our surgeons here prefer that the patients are place in low

lithotomy for easy access... the prostate is removed thru a mini laparotomy incision.... some have teds some donot strictly surgeons preference.... they prefer to use the bean bag as a safety device over the strap.

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Why the bean bag? Does the patient go into Trendelenberg or reverse Trendelenberg? And how do you fit the safety strap over the patient in lithotomy and not have the strap interfere with the surgical field?

Sorry but I'm having a hard time visualizing this...

BTW, how does the DaVinci robot work? I've heard of it but we don't use robotics in our OR. I'm assuming they tried it but it didn't work for them.

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