The Hitchhiker Position in Endoscopic Pituitary Surgery

Area of Science:

• Neurosurgery
• Surgical Techniques
• Patient Positioning

Background:

• Ergonomic and technically correct patient positioning is crucial for endoscopic transsphenoidal pituitary surgery.
• Standard practices may be challenging in large patients.

Purpose of the Study:

• To introduce a safe and ergonomic "hitchhiker position" for endoscopic endonasal pituitary and skull base surgery.
• To adapt current practices for patients with larger body habitus without compromising care.

Main Methods:

• The hitchhiker position involves securing the patient's right arm outstretched in a supine position.
• Surgeon stands in the axillary area, with specific considerations for patient comfort, immobility, and physiological support.
• Thorax elevated 25°-30° for respiratory optimization; abdomen kept free for grafts; legs positioned to prevent strain.

Main Results:

• Ten patients with pituitary tumors underwent resection using the hitchhiker position.
• Mean BMI was 40.19 ± 6.39 kg/m², with 80% classified as obesity classes 2 or 3.
• Surgeons reported reduced bodily strain and improved ergonomic access to the surgical site.

Conclusions:

• The hitchhiker position enhances both patient and surgeon well-being in endoscopic pituitary surgery.
• This positioning technique is a viable option for managing larger patients.