Lithotomy position

8.4.1 Head, shoulders and arms

In the lithotomy position, shoulder supports are used in addition to position the head. Once again, the head should be held in the middle/neutral position (O Figs. 8.23, 8.24).

The patient should be prevented from slipping if Trendelenburg positioning is required. It is also important to avoid a low position of the clavicle and to minimise pressure at the contact points, because not even well padded shoulder supports can always avoid damage to the plexus (O Fig. 8.25).

Lithotomy Position Medical Photographs

Fig. 8.23. Lithotomy position with Goepel leg holders

Lithotomy Position

Fig. 8.25. Positioning with vacuum mat and operating table in Trendelenburg position

Fig. 8.23. Lithotomy position with Goepel leg holders

Fig. 8.25. Positioning with vacuum mat and operating table in Trendelenburg position

A short vacuum mat should always be used in this position as a standard procedure for longer operations or if required by the patient's size. This distributes the pressure across the back and relieves the pressure on the shoulders.

But if the patient is positioned as shown in D Fig. 8.26, it is possible for the patient to slip in the Trendelenburg position. Without any positioning aids, the head has landed on an ECG lead. These Ā»triflesĀ« can lead to the onset of skin injuries.

Patient Lying Lithotomy Position
D Fig. 8.26. Patient slides down the operating table with head lying on the ECG cable
D Fig. 8.28. Incorrect positioning of the leg in the Goepel holder, without padding and with pressure on the head of the fibula
Lithotomy Positions With Pictures

Fig. 8.27. Comfortable leg and back positioning

Fig. 8.29. Positioning the legs in special leg holders

are inadequately adhered, so that the buttocks do not have to lie in disinfectants and body fluids.

8.4.3 Legs

Fig. 8.27. Comfortable leg and back positioning

8.4.2 Back and pelvis

Special attention and care is required when positioning the pelvis/sacrum. Excessive warmth from water mats and local loads on the sacrum will encourage the development of pressure sores. Here again, the vacuum mat can be used as a suitable precaution, because the mat moulds itself to the whole back region, distributing the contact pressure which is thus also reduced at the exposed regions of the back. A dimpled gel mat with direct body contact can be beneficial for this kind of positioning because it distributes the contact pressure better. Furthermore, a drainage effect is achieved in case the drapes

The legs are normally positioned in Goepel leg holders (D Figs. 8.23, 8.28). Another possibility is to use modern pneumatic leg holders with well padded calf boots (D Figs. 8.25, 8.27, 8.29 and 8.30). These leg holders are recommended for longer operations, because the pressure is on the soles of the feet and less on the calves. Another version is to position with feet in leg holders with removable heel loops.

It is ideal if the leg holders are fitted at the level of the hip joint to prevent the patient from slipping on the operating table if the legs are moved. The end of the foot and knee of a leg should form an axis with the opposite shoulder. Unfortunately, compartment syndrome of the lower leg is not rare after an operation lasting several hours in the lithotomy position. Repeated, regular movement of the legs (not massage) during the operation by an assistant would help to prevent positioning complications and also reduce the risk of an embolism. Here it is sufficient to

D Fig. 8.30. Diagram to show positioning of the legs in the lithotomy position
Lithotomy Positions With Pictures
Fig. 8.31. Beach-chair position

apply slight pressure to the sole of the foot to relieve the calf briefly.

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