How is the patient positioned for laparoscopic left hemicolectomy?

Updated: Apr 13, 2020
  • Author: David B Stewart, Sr, MD, FACS, FASCRS; Chief Editor: Vikram Kate, MBBS, MS, PhD, FRCS, FACS, FACG, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS, FFST(Ed)  more...
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Answer

The patient should be placed in a modified lithotomy position (see the image below). The obvious advantage of this positioning is that it allows access to the anorectum for deployment of an end-to-end anastomosis (EEA) stapler. However, another advantage is that this positioning affords the surgeon or an assistant the option of standing between the patient’s legs, which can be helpful during mobilization of the splenic flexure. For the latter reason, the author uses a modified lithotomy position for all laparoscopic operations on the small or large intestine.

Laparoscopic left colectomy. Final table and patie Laparoscopic left colectomy. Final table and patient positioning.

Having the patient firmly secured to the operating room table allows maximal Trendelenburg or reverse Trendelenburg positioning, as well as maximal left and right decubitus tilt. Especially in the absence of intra-abdominal adhesions, these extremes of body positioning improve exposure and limit the degree of tissue handling by the surgeon, serving as additional protection against iatrogenic organ injuries.

To prevent patient movement on the OR table, the author uses a beanbag to which the patient is secured (see the first image below). Silk tape (2 in. [5 cm]) is also used to secure the patient to the bean bag and the OR table. To prevent soft-tissue injury, padding is also applied over the olecranon processes and the dorsal aspects of the hands (see the second image below).

 

Laparoscopic left colectomy. Table setup in operat Laparoscopic left colectomy. Table setup in operating room.

 

Laparoscopic left colectomy. Padding for upper ext Laparoscopic left colectomy. Padding for upper extremities and shoulders used during patient positioning.

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