Lithotomy versus prone position for perianal surgery: a randomized controlled trial

Abstract

Purpose: Studies objectively comparing lithotomy and prone positions regarding surgeon comfort, ergonomics, patient comfort, and position related complications are scarce. Methods: The patients posted for surgery of either fistula in ano, hemorrhoids, or were included in this study. Subjective Mental Effort Questionnaire (SMEQ) and Local Experienced Discomfort (LED) scale were used to score the level of mental and physical stress among the operating surgeon, assistants, and the scrub nurse. Other parameters studied were the exposure of the operative site, patient comfort level, and position-related complications. Results: Thirty patients were operated in each position. Mean ± standard deviation of jackknife prone vs. lithotomy surgeon SMEQ score (15.6 ± 10.4 vs. 107.0 ± 11.5, P < 0.05) and LED score (1.8 ± 1.5 vs. 6.7 ± 0.5, P < 0.05) were found to be statistically significant. Prone vs. lithotomy assistant SMEQ score (29.1 ± 13.1 vs. 100.6 ± 8.7, P < 0.05) and LED score (4.6 ± 1.1 vs. 7.4 ± 0.8, P < 0.05) were also found to be statistically significant. SMEQ (10.0 ± 0.0 vs. 20.6 ± 2.5, P < 0.05) and LED scores (1.1 ± 0.3 vs. 3.3 ± 0.5, P < 0.05) of scrub nurses and LED scores (2.5 ± 0.5 vs. 6.3 ± 0.7, P < 0.05) of patients were also statistically significant. Exposure of the operative site was significantly better in the prone position (5.0 vs. 2.1, P < 0.05). Conclusion: Significantly better SMEQ, LED, and exposure score suggests the superiority of jackknife prone position over the lithotomy in terms of significantly less mental and physical stress to the operating surgeon, assistant, and scrub nurse; better ergonomics, and excellent exposure.

Human factors in pelvic surgery

“…Given the challenges of lithotomy position, some advocate use of prone positioning, particularly for anterior pelvic pathology. In a randomized trial of 30 patients undergoing anorectal surgery in the prone jackknife or lithotomy position, surgeons reported less mental and physical stress and better exposure in prone jackknife [50]. Proponents of the prone position hypothesized that the exposure and ergonomics were sufficiently superior to also improve oncologic outcomes; however, a meta-analysis pooling nonrandomized studies comparing prone versus lithotomy positioning for abdominoperineal resection in rectal cancer did not show an oncologic advantage [51].…”

A Randomized Controlled Comparative Study of the Three Over-Bed Techniques for Positioning and Repositioning the Lithotomy Position While Using Stirrups

“…The lithotomy position is a commonly used position in clinical surgery, and it is often employed in perineal, urethral, and bladder surgeries. 1 , 2 Although this position can provide a wider field of vision, improper placement can increase the risk of various postoperative complications. These complications may include peroneal nerve injury, deep vein thrombosis in the lower extremities, calf compartment syndrome, pain and numbness, and even motor disorders.…”