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Author Spotlight: Recent Advancements in Reoperative Foregut Surgery
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An Alternate Approach to Using Candy Cane Stirrups in Vaginal Surgery.

Eddie H M Sze1

  • 1Division of Urogynecology, Department of Obstetrics & Gynecology, State University of New York, Upstate Medical University, Syracuse, New York.

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Summary

A modified candy cane stirrup technique reduces nerve injury during vaginal surgery. This simple repositioning ensures an anatomically neutral leg position, minimizing the risk of postoperative sensory neuropathy.

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Area of Science:

  • Gynecologic Surgery
  • Surgical Positioning
  • Nerve Injury Prevention

Background:

  • Candy cane stirrups are standard for vaginal surgery, offering ample space.
  • However, their typical perpendicular alignment can cause excessive thigh flexion, abduction, and external rotation.
  • This malpositioning risks injury to critical nerves, including the femoral, sciatic, and peroneal nerves.

Observation:

  • A modified technique involves positioning stirrups parallel to the table, with slight tilting.
  • Foam pads are used, and stirrup height is adjusted for specific thigh and knee flexion.
  • Legs are then positioned vertically with minimal abduction/adduction and slight external rotation.

Findings:

  • In 1,576 cases, only eight (0.5%) instances of postoperative sensory neuropathy occurred.
  • The majority of these neuropathies involved the lateral femoral cutaneous nerve.
  • This indicates a significant reduction in nerve-related complications.

Implications:

  • This simple stirrup modification enables anatomically and neurologically neutral patient positioning.
  • It offers a safer alternative for dorsal lithotomy during vaginal procedures.
  • Minimizing nerve injury enhances patient outcomes and surgical safety.