Lithotomy Position Benefits and Drawbacks during Surgery

What Is The Lithotomy Position?

The lithotomy patient position is a variant of the supine position, which comprises lying on the back with legs bent at 90 degrees, above or at the same level as the hips. The patient's knees are also flexed at 70 or 90 degrees, where the table's padded footrests offer added support to the legs – to maintain a distance between thighs and knees.

In this position, the arms are either abducted to less than 90 degrees and held on a padded arm board or are tucked at the patient's side. Now, the foot section can be lowered to allow better surgical access to the perineum.

The lithotomy position is named after the ancient surgical procedure involving removing bladder stones and kidney stones. It enables dissection of the flap with the healthcare professional in a sitting position to boost the ergonomics of the entire medical procedure. However, this position isn't restricted to only removing bladder stones but nowadays has numerous other purposes.

There is no denying the fact that it's practically essential for all health professionals to maintain a proper patient position – that not only keeps the patient safety but also enhances the support and overall experience.

The thing is, when the patient is in the correct position, it's easier for healthcare professionals to access surgical equipment. Not only this, it improves the overall ability of surgeons and other medical assistants to perform the medical procedure.

Acquiring the perfect patient position holds utmost significance but attaining such positions requires vigilant coordination and planning by the operating room team. This supine position is quite widespread and has many variants.

Let's explore the lithotomy patient position along with its style, types, usage, and generally asked questions.

Application And Features Of Lithotomy Patient Position

The lithotomy patient position is a prevalent position normally achieved during medical examinations and surgical procedures involving the lower abdomen, rectum, genitalia, or pelvis. These medical procedures normally comprise pelvic area surgery and childbirth. The lithotomy position must be achieved during common urologic, colorectal, gastrointestinal, perineal and gynecologic procedures.

The lithotomy position has apparent benefits from the medical professional's perspective, such as providing excellent visual and physical access to the patient's perianal area.

Common Types Of The Lithotomy Position

The lithotomy position ensures that the head and spine of the patient are perfectly aligned and the neck is in a neutral position. The arms are neatly secured on a board to avoid crushing of fingers and hands. This prone position has numerous variants, such as:

1.     Low Lithotomy Position

In the low lithotomy position, the patient's lower legs are parallel to the operation room bed. The hips are flexed in a position where the angle between the bed and thighs is 40 degrees. In other words, the patient's body lays flat with legs slightly bent.

2.     Standard Lithotomy Position

In this lithotomy, the patient's hips bent until the angle among the O.R bed and thighs achieved an angle of 80-100 degrees. Even in this type of lithotomy position, the patient's leg comes parallel to the bed.

3.     Hemi Lithotomy Position

It's quite different from other types of lithotomy patient positions where his non-operative leg is placed in standard lithotomy, and the operative leg is placed in traction. In other words, one leg lays flat parallel to the bed, and the other is slightly flexed.

4.     High Lithotomy Position

In the high lithotomy position, the patient's lower legs are bent, and hips are flexed to a position where the thighs and O.R bed come at an angle of 110 to 120 degrees, at a higher position.

5.     Exaggerated Lithotomy Position

As the name suggests, the exaggerated lithotomy position places the patient's hips at an angle of 130 to 150 degrees, placing the legs vertically across the O.R bed.

When To Use The Lithotomy Position?

The lithotomy patient position is most commonly used in surgical and medical procedures such as gynecological and proctologic examinations. But, the most common application of lithotomy position can be seen during pregnancy. It's well-known due to its prevalent adoption in obstetrics as it provides good visualization of the perineal zone, helping medical professionals to make easy incisions.

The uses of the lithotomy position are briefly highlighted below:

-        Male urethral surgery

-        Female incontinence medical procedures

-        Examination of the pelvic areas

-        Urologic examinations of the prostate

-        Ureteroscopy

-        Perineal resection or transurethral of the bladder

Lithotomy Position During Surgery

Before any surgical procedures, the patients should be transferred to an operating table, where the patient is placed in the appropriate position depending on the type of medical examination or procedure. The patient can assist before any anesthesia is given, but after the induction, the operating room team must carefully move and position the patient.

Bear in mind that all the patient's pertinent comorbidities should be reviewed, ensuring additional staff for proper positioning of the patient with special needs such as spinal fractures or obesity. During surgical procedures, the patient is placed in a position where hips and knees are flexed with legs properly abducted.

However, when the patient is not positioned in the appropriate position, it may lead to numerous complications such as:

-        Acute Compartment syndrome is when the pressure builds on one specific body area.

-        Peripheral nerve injuries include ankle extension, foot dorsiflexion, and ankle eversion.

-        Lateral femoral nerve injuries resulting from increased thigh pain or meralgia paresthetica.

-        Other common injuries such as tendon strain, sciatic nerve injury, hip dislocation, muscle strains, pressure injuries, and low back strain.

Lithotomy Position During Childbirth

The lithotomy position during childbirth gives doctors and gynecologists good access to the mother and baby. The mother-to-be lies on the dorsum with the knees and hips flexed at 90 degrees. Undeniably, the second stage of labor is the most stressful part of the childbirth process, and it's essential to achieve the proper maternal position to ensure safety during vaginal birth.

It was standard practice during childbirth procedures, but recently, most hospitals have moved away from this position and shifted to birthing chairs or beds as studies have proven that the lithotomy position could result in added pain in the mother during the second or third stage of labor.

In case the appropriate maternal position isn't achieved, then it could lead to:

-        Increased chance of receiving sphincter injuries due to increased pressure

-        Higher chances of needing an episiotomy or caesarian section (forceps)

-        At times, it increases the need to cut the tissue between the anus and vagina called the perineum

-        Higher risks of perineal tears

-        Increases risks of sphincter injuries due to increased pressures

-        Other injuries such as fecal incontinence, pain, discomfort, and sexual dysfunction

Lithotomy Position During Pelvic Examination

Undeniably, the lithotomy position is great for medical examinations involving the lower abdomen and the pelvic region. When the patient is appropriately in the lithotomy position, it's pretty easy for the medical professional to perform the pelvic examination and ascertain the position and size of the uterus.

Lithotomy Position On Medical Devices

Medical equipment plays a significant role in keeping patients safe during medical procedures and examinations. Here is the list of a few medical devices that can help healthcare professionals achieve proper lithotomy positions.

1.     Surgical Tables

The electro-hydraulic O.R table offers multiple surgical applications.It is made up of an antistatic management mattress with stainless steel accessories designed to simplify various surgical treatments. It offers versatility and adoption across a wide variety of medical operations.

2.     Surgical Accessories

The surgical accessories helping doctors and other healthcare professionals include:

-        Leg Holders and Stirrups

-        Short Featherweight leg section

-        Fluid Collection System

-        Transfer board

3.     Birthing bed

The birthing bed comprises two models: Electric Gynecology Obstetric Delivery Bed AG-C309 and Electric Gynecological Examination Table For OBGYN AG-S105C, which cost more than $3,000. Both offer ergonomic design, an auxiliary table, and a central control portion giving complete control in the hands of the medical assistants.

FAQs

1.     What is the lithotomy position used for?

The lithotomy position is generally used for urologic, colorectal, gastrointestinal, perineal, and gynecologic examinations and childbirth.

2.     How do you put a patient in lithotomy?

It's a variation of the supine position where knees and hips are bent at an angle with legs abducted on the table for easy access.

3.     What are the 4 variations of the lithotomy position?

The four variations of lithotomy positions include Low, Hemi, High and Exaggerated lithotomy, varying with the patient's leg placement.

4.     What are the advantages of the lithotomy position?

The most obvious benefit of the lithotomy position is that it offers good visual and physical access to the perineal area.

5.     When is a patient placed in a lithotomy position?

The patient is normally placed in a lithotomy position during a wide variety of treatments ranging from pelvic exams to surgeries involving urology, reproductive organs, and gastrointestinal systems.

Bottom Line

The lithotomy patient position is widespread and used in hospitals for several medical examinations and procedures such as pelvic examination and childbirth. However, numerous studies have linked the use of this position with increased risks of several complications.

Depending on the situation and type of surgical procedure, the lithotomy position's benefits and risks vary significantly. So, getting the best medical equipment for your patient to deliver the utmost safety is essential.

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