Utility of High-positioning Pelvic Pads in Laparoscopic Sigmoid Colon and Rectal Surgeries

The increased use of robotic rectal surgery has raised concerns regarding the increase in postoperative complications, e.g., compartment syndrome, associated with factors such as the Trendelenburg position, use of the adjustable lithotomy stirrup, and prolonged surgical duration. Therefore, in this study, we evaluated the utility of high-positioning pelvic pads during laparoscopic rectal and sigmoid colon surgeries, which is employed in our institution to maintain a stable body position with reduced head-down tilt.

We included patients who underwent laparoscopic sigmoidectomy and rectal resection at Shinshu University Hospital between January 2016 and December 2021. We performed two studies: Study 1 compared the short-term treatment outcomes between patients who used high-positioning pelvic pads during surgery and those who did not, whereas Study 2 analyzed factors affecting the time to inferior mesenteric artery division using multivariate analysis.

In Study 1, no significant differences in patient demographics were observed between the groups. The use of high-positioning pelvic pads significantly reduced the overall surgical time and number of gauzes used, with no significant differences in blood loss, complication rates, or duration of hospital stay. In Study 2, we identified intra-abdominal adhesions requiring adhesiolysis and use of high-positioning pelvic pads as factors influencing the time to inferior mesenteric artery division.

The use of high-positioning pelvic pads facilitated surgeries with a reduced head-down tilt, thereby contributing to shorter surgical times. This approach may help decrease the incidence of compartment syndrome, suggesting the need for further prospective trials and studies on robotic surgery.