The lithotomy position is frequently utilized in gynecologic and urologic surgeries. In this position, the patient lies on their back with the hips and knees flexed, and the legs supported in stirrups, providing optimal access to the pelvic and perineal areas. Proper technique and attention to detail are essential to prevent positioning-related complications.
Indications for Lithotomy Position:
- The lithotomy position is commonly used for gynecologic and urologic procedures, as it allows surgeons unobstructed access to the pelvic and perineal regions.
Moving the Patient:
- When placing the patient into and out of the lithotomy position, both legs should be moved simultaneously to prevent torsion of the lumbar spine. This coordinated movement helps maintain spinal alignment and reduces the risk of injury.
Hip and Leg Positioning:
- The hips should be flexed 80 to 100 degrees from the trunk, and the legs abducted 30 to 45 degrees from the midline. This positioning ensures adequate exposure of the surgical site while maintaining patient comfort and safety.
Padding the Lower Extremities:
- Lower extremities should be adequately padded to prevent compression against the stirrups and injury to the common peroneal nerve. Proper padding distributes pressure evenly and reduces the risk of nerve damage and pressure sores.
Positioning of Hands and Arms:
- Hands and arms should be positioned away from the bed to prevent crush injuries during manipulation of the foot section of the operating room table. This precaution helps protect the extremities from being accidentally injured during adjustments.
Physiologic Changes
- Normal hemodynamic changes involve increased venous return along with transient increases in preload and cardiac output. Respiratory changes occur due to the upward displacement of abdominal contents, leading to decreased lung compliance, functional residual capacity, and tidal volume.
- In some cases, the lithotomy position can increase intra-abdominal pressure, potentially impeding venous return to the heart. Obese and parturient patients are at an increased risk. This increase in pressure can lead to decreased cardiac output and hemodynamic instability. Monitoring and adjusting the patient’s position as necessary can help mitigate these effects.
