Positioning techniques depending on various surgical indications

14.1.1 Supine position

Indications

Operations to:

Penis: e.g. penis deviation (Nesbit), hypospadia correction, epispadia correction.

Testicles: e.g. vasectomy, varicocele ligature, vasovasostomy and epididy-movasostomy, microepididymal and testicular sperm extraction (MESA and TESE), spermatocelectomy, epididymectomy.

Abdominal operations: e.g. suprapubic cystostomy, retroperitoneal lymph-adenectomy, transperitoneal nephrectomy possibly with cavotomy and tumour thrombectomy, intraperitonealisation of the ureters, augmentation of the bladder, ureterocystoneostomy, ureter resection and reconstruction, ureterolithotomy.

Preparations

4 Arm positioning devices Positioning

4 Standard operating table position 1, position 2 or universal operating table

4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices 4 Normal positioning of the operating table in the theatre 4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure 4 Spread out both arms on the arm positioning devices 4 Apply the neutral electrode and connect to the HF surgery device 4 Arrange absorbent drapes or self-adhesive covers for preoperative skin disinfection 4 Position the operating lights 4 Patient warming system

Ureteral Stent Placement ProcedureUrethral Sphincter EndoskopyUrethral Sphincter Endoskopy
D Fig. 14.3. Maximum 90° abduction and supination position of the arms

14.1.2 Lithotomy position

O Figs. 14.4-14.7. Indications

All endourological operations: urethrocystoscopy, transurethral resections (bladder, prostate), punch lithotripsy, retrograde presentation of the upper urinary tract, placement of ureter stent (pigtail), ureter endoscopy (with biopsy and stone extraction).

Penis: total penectomy with placement of the neourethra. Urethra: open-surgery urethra grafts, excision of urethra diverticula, complete urethrectomy.

Prostate: transvesical adenoma nucleation, pelvic lymphadenectomy and radical prostatectomy.

Bladder: radical cystectomy with continent or incontinent substitute bladder, bladder elevations for stress incontinence, Scott sphincter implantation, vesicovaginal fistula occlusion.

Preparations

4 Arm positioning devices

4 2 Goepel leg holders or 2 special pneumatic leg holders and 2 adapter pieces 4 Gel pad

4 Possibly 2 shoulder supports Positioning

4 Standard operating table position 2 or universal operating table 4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices 4 Normal or diagonal positioning of the operating table in the theatre 4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure 4 Spread out and pad both arms on the arm positioning devices 4 Adapt the Goepel leg holders with the provided champs 4 Position the legs and remove the leg plates 4 Position the pelvis slightly over the edge of the buttocks plate 4 Check the leg positioning: lower the still raised legs until the thighs are nearly horizontal

4 Possibly position the legs again in this phase and raise them again after the end

4 Apply the neutral electrode and connect to the HF surgery device 4 Arrange absorbent drapes or self-adhesive covers for preoperative skin disinfection 4 Position the operating lights 4 Patient warming system

Lithotomy Position
D Fig. 14.4. Lithotomy position with Goepel leg holders
Lithotomy Position Operation Theatre
Fig. 14.5. Lithotomy position with vacuum mat and leg holders with one-hand operation
Surgical Leg Holders

Fig. 14.6. Positioning with lowered leg holders and positioning on vacuum mat

Partial Nephrectomy Positioning Surgery

Fig. 14.6. Positioning with lowered leg holders and positioning on vacuum mat

D Fig. 14.7. Diagram to show the optimum positioning of the legs in the lithotomy position

O Figs. 14.8-14.10. Indications

Kidneys: percutaneous nephrostomy, kidney and kidney cyst puncture possibly with sclerosing, percutaneous nephrolitholapaxy, nephropyeloplasty, tumour nephrectomy, partial nephrectomy, pyelolithotomy, nephrolithotomy, adrenalectomy.

Preparations

4 Arm positioning devices

4 Gel ring, gel cushion, Goepel leg holder, lateral supports, radial adjusting clamps, padded cushions (normal and flat) and wedge cushions or tunnel cushions, body belts

Positioning

4 Standard operating table position 1 or universal operating table 4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices 4 Normal positioning of the operating table in the theatre 4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure 4 Fit the radial adjusting clamp to the side rail of the head plate, position the

Goepel leg holder and place a gel padded mat on the operating table 4 Spread out the arm on the side not being operated 4 Move the patient onto the healthy side, with the back near the edge of the operating table

4 Gradually hinge open the operating table by lowering the pelvic and back plate (operating table in roof position) 4 Raise the head plate and position the head on a padded cushion with gel ring to leave the ear free 4 Position and fix the arms

4 Move the lower arm forwards so that the weight of the upper body does not lie directly on the shoulder 4 Thorax 90° position, pelvis 45° position

4 Fit the radial adj ustment clamps to the small side rails of the leg plates and position the body supports on the level of the sacrum and symphysis 4 1st possibility: position the legs with the padded cushions (normal and flat) and possibly wedge cushions 4 Fix the lower leg and positioning aids with the body belts 4 2nd possibility: position the legs with the tunnel cushions 4 Position the upper leg in external rotation 4 Apply the neutral electrode and connect to the HF surgery device 4 Arrange absorbent drapes or self-adhesive covers for preoperative skin disinfection 4 Position the operating lights 4 Patient warming system

Patient Positioning Nephrectomy
D Fig. 14.10. The operating table is moved as far as possible towards the head to allow for an optimum flex position

14.1.4 Modified supine position

O Figs. 14.11, 14.12. Indications

Kidney and ureter: nephroureterectomy, tumour nephrectomy Neuromodulation: implanting the neuromodulation stimulator.

Preparations

4 Arm positioning devices

4 Wedge cushions, radial adjusting clamps, body supports Positioning

4 Standard operating table position 1, position 2 or universal operating table

4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices

Normal positioning of the operating table in the theatre 4 When positioning the patient, take appropriate measures to prevent decubitus at areas which are subjected to pressure 4 Spread out and pad both arms on the arm positioning devices 4 Apply the neutral electrode and connect to the HF surgery device 4 Arrange absorbent drapes or self-adhesive covers for preoperative skin disinfection 4 Position the operating lights 4 Patient warming system

Surgical Body Positions

O Figs. 14.13-14.17. Indications

Neuromodulation: percutaneous neuromodulation testing, implanting the neuromodulation electrodes.

Preparations

4 Two arm positioning devices 4 Special head positioning cushion for prone position 4 Thorax, pelvic and wedge cushion, padded roll

Positioning

4 Standard operating table position 1, position 2 or universal operating table 4 Anaesthetic preparation and induction in supine position with 2 adapted arm positioning devices 4 Transfer to the prepared operating table in the induction room 4 Position both tables next to each other, with the prepared table lowered 4 Place the patient in prone position on the padded cushion of the prepared operating table and take him into the theatre ~ Normal positioning of the operating table in the theatre 4 Position the head on the special head positioning cushion 4 Position both arms on the arm positioning devices 4 Apply the neutral electrode and connect to the HF surgery device 4 Arrange self-adhesive covers for preoperative skin disinfection 4 Position the operating lights 4 Patient warming system

O Fig. 14.13. Prone position with padded cushions for prone positioning and gel cushion for anatomically correct positioning of the cervical spine and head (universal operating table 1150.30)

O Fig. 14.13. Prone position with padded cushions for prone positioning and gel cushion for anatomically correct positioning of the cervical spine and head (universal operating table 1150.30)

Arm Abduction Table PositioningProne Position Operation Theatre Photos

D Fig. 14.15. Arms positioned in maximum 90° abduction and arm positioning device adapted at shoulder height

Positioning The Prone Surgical

15.1 Cervical spine - 186

15.1.1 Supine position/CRP horseshoe-shaped headrest - 186

15.1.2 Supine position/skull clamp - 188

15.1.3 Supine position/spine holding unit MAQUET T554.0000 - 190

15.1.4 Prone position/CRP horseshoe-shaped headrest - 192

15.1.5 Prone position/spine holding unit / skull clamp - 194

15.2 Thoracic spine, lumbar spine - 196

15.2.1 Prone position - 196

15.2.2 Lateral position - 198

15.2.3 Supine position - 200

+15 -7

Responses

  • Bucca
    What are the indication for supine position in theatre?
    3 years ago
  • szymon watson
    What are the indications for supine position in the theatre?
    3 years ago
  • ponto twofoot
    What are the five positions used in theatre and their indications?
    3 years ago
  • maciej
    What are the indications prone position in theatre?
    3 years ago
  • tesfalem
    What are the 5 common surgical positions and their indications?
    3 years ago
  • lionella
    What are tge difference positiins and their indication?
    2 years ago
  • sesuna
    Which position given to the renal surgery in operation theter?
    2 years ago
  • Giosu
    What it positon used in theatre?
    2 years ago
  • ernesto
    How to fixthe leg in lithotomy position?
    2 years ago
  • Tyler
    What are the different surgical positions and their safety measures?
    2 years ago
  • Nile
    What is position in theater?
    2 years ago
  • chica
    Why are arms out on operating table?
    2 years ago
  • semira
    What are the common positions used in surgery?
    2 years ago
  • LUCA
    What are the various position given for supine surgry?
    2 years ago
  • saara
    What are types of positions used for the various operations procedures?
    2 years ago
  • semhar
    What are the positions used in theater for operations?
    2 years ago
  • brodie hunter
    What are various positions used for surgery and their inditions?
    2 years ago
  • Steffen
    What are commonly used position in theatre?
    2 years ago
  • Marcel
    What are indication of operation bed?
    2 years ago
  • Massawa
    What are the veriours position used in teather?
    2 years ago
  • jan wulf
    How many types of surgery of various position?
    2 years ago
  • hyiab
    Which position used in kidney operations?
    2 years ago
  • kalervo
    What Lithotomy surgical positon in use?
    2 years ago
  • SAMI
    Which position is given in abdominal surgery?
    2 years ago
  • stefan
    How many types of position in operation theater?
    2 years ago
  • Pamphila Fairbairn
    What procedure operation is used in supine position?
    2 years ago
  • sirkka seppinen
    What are the type of positoning in surgical patient?
    1 year ago
  • Kerris
    What art the various anatomical position during oprration?
    7 months ago
  • Karri Poutanen
    What determines body position on operating table?
    3 months ago
  • fearne
    What type of table is used for a nephrectomy?
    3 months ago
  • marigold
    How mini types of position in surgical?
    17 days ago
  • darcy
    How many positiom in opration?
    6 days ago

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