Patient position in perineal surgery

1. POSITIONING OF PATIENTS IN
PERINEAL SURGERY
By
Rengan D
www.surgicaltechie.com

2. LITHOTOMY POSITION
Lithotomy Position
• The patient lies supine on the operating
table.
The thighs and knees are flexed and
supported
on stirrups .
• Additional padding should be placed
under the posterior compartment muscles
of the legs to reduce the risk of pressure
ulceration.

3. SAFETY PRECAUTIONS
The legs are secured onto the stirrups
with crepe bandaging. This position is routinely
used for cystoscopy, as it provides good
exposure
of the perineum.
• Both the legs must elevated simultaneously by
two peoples
• Rising both legs at the same time keeps the
body in the alignment and prevents twisting of
lumbar spine.
• Both the arms are tucked at the sides of the
body & care must be taken to ensure that
patient fingers do not become impinged as

4. Lithotomy Position

5. 1.When the legs are placed in the stirrups
the knee must be flexed first keeping them in
the middle position, then the thigh’s are
abducted while the knees are flexed after
anaesthesiologists gives permission.
2. Secure the compression area joints with
cotton pads, use the soft bandages or belts to
secure the legs.
3.The side edge of the both hands must be
secured and kept abducted within 90degree.

6. Complications
❖Nerve compression like popiteal nerve,
femoral nerve, ulnar nerve& radial nerve.
❖Damage of achilles tendons.
❖Post operative discomfort to the patient.

7. JACKKNIFE POSITION
It’s a modification of prone position.
● General safety measures for Kraske
(jackknife) position:
● (1) All general safety measures for the
prone position apply to the Kraske
position.
● (2) The hip joints should be over the
middle break of the OR table.
● (3) The head should be turned towards the
non-affected or nonoperative side.

8. Acheivements of position
● (4) The OR table should be moved into the
Kraske position slowly. The patient should be
closely observed to ensure the body maintains
position, and the hip joints remain over the
middle break.
● (5) The safety strap should not be placed until
after the position has been achieved. If the
safety strap is placed prior to positioning, such
as during movement of the OR table, the
safety strap could cause shearing and friction
injuries. The safety strap should be placed
above the knees.
● (6) The patient should be returned to the
horizontal prone position as soon as possible.

9. SAFETY PRECAUTIONS
• Spine must be kept in a neutral position
during the positioning.
• A sufficient clearance must be allow deep
lung inflation.
• In female patient the breast must be
protected.
• Forcing the breast laterally during position
can cause bleeding & tearing of deep tissue
at the margins.

10. COMPLICATIONS
● Damage of subclavian & brachial plexus
causes thoracic outlet syndrome, risk of
sever injury to the cervical spine.
● Corneal abrasion causes blindness.

12. PRONE POSITION
INDICATIONS
This position is mainly used to allow access to spine,
cranium& perineal regions.
Prone Position
The patient is placed flat, face downwards on
the operating table, with their arms at their side.The face
is supported with a head ring and the endotracheal
tube position is safely secured.
This position may be used for closure of
myelomeningocele and excision of sacrococcygeal
teratoma.

13. POSITIONING OF PATIENTS
▪ Align the stretcher with the operating
table
▪ Perform the catheterization and secure it,
before positioning the patient.
▪ Before positioning inform to
anaesthesiologists, (by way they secure the
IV lines. Disconnect the patient ventillation
circuit temporarily).
▪ Head is hold by anaesthesia care provider,
two peoples are ready to receive the
patient to the OT table.

14. Contd.,
Keep cotton pads in eyes, elbow
joints,ankles, knees, male genital area.
Keep a chest roll at the edge of 10th
intercoastal rib.and a axillary roll.
Keep a gel pad or roll at the level of iliac
spines, leaving abdomen free.
The hand must be abducted 90degree /less
than 90 degree.

15. COMPLICATIONS
✓ Postoperative discomfort to the patient.
✓ Damage of popiteal nerve, radial& ulnar
nerve, brachial plexus.
✓ Post operative pain to the patient.
✓ Damage of cervical spine.
✓ Discomfort to the patient.
✓ Uneasy to handled by anaesthesia care
provider.
✓ Chances of airway obstruction.

16. Complication of prone position
➢Unintentional extubation
➢Eye complications: corneal abrasions,
conjunctival and periorbital
➢edema of the dependent eye, retinal
ischemia, post-operative
➢lymphatic obstruction).
➢Macroglossia.
➢Possibility of venous air embolism

17. Complication of prone position
➢visual loss due to ischemic optic
neuropathy.
➢Entangling of cables.
➢Abdominal compression (leading to
impaired ventilation, increased
➢bleeding, and decreased cardiac output).
➢Improper head and neck positioning
(leading to venous and

19. The End
For more
Visit
www.surgicaltechie.com