A quality improvement project for safe and effective patient positioning during robot-assisted surgery

During the initiation of a new robotic surgery program, a quality improvement team explored different techniques for positioning patients in the lithotomy and steep Trendelenburg position during robot-assisted procedures. Concerns associated with placing patients in the steep Trendelenburg position include the patient slipping toward the head of the bed and experiencing hemodynamic changes that may result in a rise in blood pressure, increased intraocular and intracranial pressures, and difficulty with ventilation, particularly in patients with a high body mass index. Skin integrity is also of concern because perioperative personnel are responsible for protecting the patient's skin from excessive sheer, friction, and injury. The quality improvement team evaluated and compared two positioning devices: an air-inflated positioning device and high-density foam padding. Both methods allowed personnel to position the patient without compromise; the surgeons performing the robot-assisted procedures preferred the high-density foam padding.