Correct and stable positioning of the patient is the first step for a successful operation. Safe arm and leg positioning are crucial in preventing pressure lesions, such as ulnar or peroneal neuropathy.
The supine position is used for most abdominal procedures. The arms can be left out (A-1) or kept close to the body (A-2), depending on the type of operation to be performed.
■ Anchor the patient's legs and/or ankles with a strap in case tilt is required
■ Protect arms with a pillowcase, gauze sponge, or silicone pad
■ Avoid traction on the brachial plexus (abduction of the shoulder should be <90°)
The French position is one possible patient position for a laparoscopic cholecystectomy (the "American" supine position with both arms tucked alongside the body being the other).
■ The patient's legs are placed in stirrups or supported under the knee
■ Legs need to be placed horizontally or slightly declining to allow free movements with laparoscopic tools
■ Avoid any pressure on the peroneal (lateral popliteal) nerve
Beach Chair Position
The beach chair position is used for most laparoscopic obesity surgery procedures
■ Requires a special weight-bearing table
■ The patient is "sitting" on the table
■ Avoid any pressure on arms, the brachial plexus, and the peroneal (lateral popliteal) nerve
Positioning for Esophageal Surgery
For esophageal resection and reconstruction, several approaches can be used. Depending on the location of the disease and the surgical approach, the positioning is adapted accordingly.
The positions used are:
a) Supine position with overextended thoracic spine, the head rotated to the right and extended. The right arm is left out and the left arm is tucked alongside the body (A) . This position is commonly used for transhiatal esophagectomies enabling:
- Good exposure of the upper abdomen
- Good exposure for the cervical anastomosis b) Right or left lateral decubitus (B)
- For the intrathoracic anastomosis
- Procedures on the upper thoracic esophagus are approached via a right posterolateral thoracotomy, and similar procedures on the lower esophagus are best approached through the same incision on the left side
- The table is slightly kinked at the thoracic level, further opening the thoracic cavity after thoracotomy c) 45° lateral decubitus or screw position (C)
- An advantage is that the abdominal, the thoracic, and/or cervical phase of the procedure can be performed without changing the position
- For optimal access, the operating table can be tilted
- The main disadvantage is a more limited exposure
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