Patient positioning in laparoscopic surgery: Tricks and tips

Clinical Issues—January 2018

“…The patient's hips are particularly vulnerable to excessive rotation and hyperabduction . Excessive rotation or abduction (ie, more than 30 to 45 degrees) puts stress on the patient's hip joints and can cause a femoral, sciatic, obturator, or common peroneal neuropathy . When using candy cane–shaped leg holders, there is potential for the patient's lower extremities to rest against the vertical leg‐holder posts, which increases the patient's risk for injury to the common peroneal nerve .…”

Implementing AORN Recommended Practices for Minimally Invasive Surgery: Part I

“…9 Positioning interventions include padding the gutter armrest and placing the arm in a neutral position with the patient's hand flat against the thigh, wrapped with padding, and tucked at his or her side to offer maximal protection to the extremity. The exaggerated patient positioning that is used during MIS and computer-assisted techniques offers better access and visibility of the surgical site by moving the bowel out of the pelvis but may lead to an increased risk of injury.…”

“…10 Using a vacuum-pack positioning device mattress helps limit the risk of brachial plexus injuries and prevents the patient from sliding. 9 Positioning lower limbs in boots with heel supports, abducting lower limbs less than 90 degrees, and maximizing lateral hip rotation helps minimize potential compression injuries. 9 Positioning lower limbs in boots with heel supports, abducting lower limbs less than 90 degrees, and maximizing lateral hip rotation helps minimize potential compression injuries.…”

Intraoperative surgical and anesthesiological problems and the consequences for surgery

“…Aber auch direkte Schädigungen der Haut oder Unterhaut durch entstandenen Druck bis hin zu einem Kompartmentsyndrom oder einer Rhabdomyolyse können vorkommen und müssen vermieden werden [2]. Nach Absprache der Berufsverbände der Anästhe-siologie und der Chirurgie von 1987 ist der Chirurg für die intraoperative Lagerung verantwortlich.…”

“…Tab 2. Literaturübersicht zum Volumenmanagement bei abdominellen, kolorektalen operativen Eingriffen Anästhesiologisch geführte Studien befassen sich zum Großteil mit der GDT, während chirurgisch geführte Studien vor allem das Konzept der restriktiven vs. liberalen Volumentherapie untersuchen.…”