Lithotomy position

Last revised by Frank Gaillard on 25 Dec 2023

The lithotomy position is a surgical position employed in medical imaging and surgical procedures wherein the patient lies supine on an examination or operating table with their buttocks at the table's edge. The lower limbs are flexed at the hips and knees, abducted, and supported in stirrups. This arrangement provides optimal access to the perineal and pelvic regions, facilitating procedures such as urological and gynecological examinations, interventions, or imaging studies. The lithotomy position ensures proper exposure of relevant anatomical structures while allowing for convenient maneuverability and access for medical professionals.

The lithotomy position was - and is - also used classically for childbirth, although in recent times, this has fallen out of favor to some degree, with a modern emphasis on giving pregnant women much greater freedom in the position that they adopt.

The lithotomy position continues to be employed for various procedures:

  • transperineal prostate biopsies 2


Historically "cutting the stone" was likely the first surgical technique for a single surgical disease, with written references back to the time of the Ancient Egyptians 1. This procedure was used to extract a bladder stone by a perineal approach, and in the pre-anesthetic era, this must have been extremely painful. Indeed until the Renaissance the operation was generally performed in children only, usually boys. The enlarging prostate in men precluded the operation in adults.

The pediatric patient sat on the lap of a strong assistant who restrained them, holding the legs open wide with knees flexed up against their trunk, this of course is the essence of the lithotomy position. The surgeon stood or sat looking towards the perineum of the patient, and performed an incision anterior to the anus, cutting up to the bladder, thereby freeing the calculus from the bladder, which was dislodged by the surgeon's finger which was in the rectum. Occasionally additional instrumental manipulation might be required, by use of forceps or a specially designed hook.

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