What are the surgical positions?

Time:2024-02-22

Surgical positions are chosen to facilitate the operation and are tolerated by the patient. Most surgeries are performed in the supine position, while others include the prone position (e.g., spinal and anal surgery), lateral position (e.g., certain open-heart surgeries), seated position (e.g., tonsillectomy), truncated position (for surgeries of the anus, perineum, vagina, etc.), and Trendelenburg’s position (Trendelenburg’s position – the head is lowered to the feet, and the small bowel is moved to the epigastrium, and the large omentum is moved to the pelvic organs), etc. We will discuss each of these positions below, greater omentum, etc. moves to the epigastrium, suitable for surgery on pelvic organs), etc., which we will discuss below.

 

 

Supine Surgical Position

 

The horizontal supine position is the most commonly used surgical position.

surgical position, supine position, supine surgical position,lateral surgical position,prone surgical position

Requirements for the position: let the patient lie naturally on the operating table, with a thin pillow on the head to maintain the forward flexion position, so that the neck muscles can be relaxed to facilitate venous return. The arms are naturally straightened near the torso and secured with fabric wraps, or the arms are abducted.

 

 

Trendelenburg Surgical Position

 

This is a modified supine head-down position, which is commonly used for lower abdominal and pelvic surgery, and is also suitable for internal jugular or subclavian vein puncture.

surgical position, supine position, supine surgical position,lateral surgical position,prone surgical position

Requirements: The patient should lie on his/her back with the popliteal fossa in the folded area of the operating bed; the operating bed should be placed in a 10°-15° head-down slope position, and the leg boards should be lowered by 15°-30° to allow the knees to drop in flexion so that the patient does not slide down towards the head.

 

Note: In the flexed position, CVP, pulmonary venous pressure, intracranial pressure, and intraocular pressure increase, cardiac work increases, and thoracic and pulmonary compliance and FRC decrease. Edema of the face, eyelids, bulbar conjunctiva, and tongue can occur in those who have had a long surgery, and symptoms of bruising of the head and neck

 

 

Lithotomy Surgical Position

 

For perineal surgery.

surgical position, supine position, supine surgical position,lateral surgical position,prone surgical position

Positioning requirements: the patient lies on his back with both upper limbs close to the torso; the patient is moved down so that the sacrococcygeal region is located at the lower edge of the backboard of the surgical bed; both thighs are abducted at an angle of 60°-90° and placed on the leg braces and secured with hosiery or wrapped in a soft fabric.

A soft cushion should be placed on the leg braces to avoid the leg braces being too high and compressing the popliteal fossa to avoid serious complications such as peroneal nerve injury or arteriovenous embolism.

 

Note: Elevation of the lower limbs can increase the return blood volume, and when the lower limbs are suddenly flattened to reduce the return blood volume, the hemodynamic impact is greater, especially for those with poor cardiac function should pay special attention.

 

 

Lateral Surgical Position

 

Commonly used in thoracotomy.

surgical position, supine position, supine surgical position,lateral surgical position,prone surgical position

Position requirements: the patient’s surgical site on the upper, back plane near the edge of the operating table and perpendicular to the operating table.

The head and neck maintain a normal relationship with the torso, and the head is padded with a slightly thicker headband to avoid excessive pressure on the shoulders and ears.

The lower extremities are placed in hip and knee flexion close to 90°, which facilitates fixation of the lateral position and relaxation of the abdominal wall.

The upper lower limbs can be kept in a straight position with a soft pad between the knees and thighs. Both upper limbs are stretched forward and parallel, or perpendicular to the torso, or the elbow flexion is slightly overstretched toward the head, and fixed with a double brace.

 

 

Prone Surgical Position

 

For spinal, posterior cranial fossa and other back surgeries.

surgical position, supine position, supine surgical position,lateral surgical position,prone surgical position

Position requirements: after stable anesthesia, in general, the anesthesiologist grasps the head and endotracheal tube for rotation, while those who have cervical spondylosis and intend to carry out cervical spine surgery, the specialist should be responsible for grasping the patient’s head position, and the patient’s arms will be lowered tightly against the torso, and the spine will be slowly rotated to one side for the prone position under the situation of keeping the head with the neck and the thorax in a normal position.

 

 

Kidney Surgical Position

 

Suitable for surgery of anus, rectum and kidney area.

surgical position, supine position, supine surgical position,lateral surgical position,prone surgical position

Requirements for the position: Let the patient take the prone position or lateral position first, the pubic symphysis should be located at the lower edge of the backboard of the surgical bed, and the back of the foot should be outside the edge of the leg board, and the surgical bed should be swung to the backboard at a low angle of 15 ° and the leg board at a low angle of 30 °, so as to make the patient into a folding knife shape.

 

 

Sitting Surgical Position

 

Mainly used for surgery in the posterior cranial fossa and cervical spinal cord area.

surgical position, supine position, supine surgical position,lateral surgical position,prone surgical position

Positioning requirements: the upper 1/3 of the operating table is placed with the head 45° high, the middle 1/3 is placed with the head 45° low, and the lower 1/3 is placed with the feet 10°-15° low. The patient is seated at the junction of the upper and middle 1/3 of the operating table, while the lower legs are placed in the lower 1/3.

The head is supported and fixed with a special brace, and the head is kept in a flexed position so that the back of the neck can be straightened, but a certain distance should be maintained between the lower jaw and the sternum, generally two fingers’ distance is appropriate to prevent ischemic injury of the spinal cord. The upper arms of the two upper limbs should be immobilized on both sides of the torso to avoid brachial plexus nerve injury due to excessive abduction of the upper limbs by gravity.

 

Conclusion

 

The correct setting and maintenance of the surgical position is one of the key determinants to ensure the successful implementation of surgery. During surgery, proper body position can not only provide surgeons with the best surgical vision and operating space to ensure that surgical instruments can reach the surgical area accurately and unobstructed, but also is crucial to protect the patient’s life safety and postoperative recovery.

 

Correct body position design can avoid pressure injuries caused by prolonged fixed posture, such as bedsores, nerve damage and other complications; at the same time, it can also effectively prevent accidental injury to vital organs and structures during surgery, and help to reduce the amount of bleeding and promote postoperative wound healing. In addition, a good surgical position also facilitates the anesthesiologist’s airway management as well as the monitoring of vital signs, thus maintaining the overall stable state of the patient during the perioperative period.

 

Therefore, from the preparation to the completion of surgery, careful planning, placement and continuous monitoring of the surgical position is undoubtedly an important guarantee for the smooth progress and ultimate success of surgery.

 

Leave a Reply

Your email address will not be published. Required fields are marked *