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"On table" positioning for optimal access for cancer excision in the lower rectum
Koutarou Maeda1, Morito Maruta, Harunobu Sato
1Department of Surgery, Fujita Health University School of Medicine, 1-98 Kutsukake, 470-1192 Toyoake, Aichi, Japan. kmaeda@fujita-hu.ac.jp
World Journal of Surgery
|March 17, 2004
Summary
Patient positioning during lower rectal surgery can significantly improve surgical outcomes. The "thighs-flat" position enhances pelvic visualization and access compared to the traditional lithotomy position, aiding rectal cancer excision.
Area of Science:
- Surgical Oncology
- Anatomical Studies
- Surgical Positioning
Background:
- Excising lower rectal tumor lesions is challenging due to poor visualization and restricted access, especially in narrow male pelves.
- Current surgical positioning may not optimize accessibility for lower rectal surgery.
Purpose of the Study:
- To investigate the impact of different patient positions on operating tables to improve accessibility for lower rectal surgery.
- To quantify the extent to which patient positioning affects pelvic geometry and surgical access.
Main Methods:
- Twenty patients undergoing laparotomy for lower rectal surgery were studied.
- Pelvic geometry was assessed using lateral radiographs in four different patient positions.
- Comparison of the conventional lithotomy position with the "thighs-flat" position, with and without a "lumbar pad".
Main Results:
- The "thighs-flat" position induced significant lumbosacral joint extension compared to the lithotomy position.
- Augmented lumbar lordosis widened the pelvic view and improved the angle of visualization of the lower rectum.
- The "thighs-flat" position provided a more vertical view (13.0 degrees) compared to the lithotomy position (27.5 degrees), further enhanced by a "lumbar pad".
Conclusions:
- The "thighs-flat" patient position is superior to the conventional lithotomy position for lower rectal surgery.
- This improved positioning enhances both visibility and accessibility within the pelvic cavity, facilitating tumor excision.