Surgical positions

Last revised by Daniel J Bell on 1 Jul 2019

There are various classic surgical positions for patients to be placed in for procedures, which have been adopted/repurposed for interventional radiology and some diagnostic procedures:

  • lithotomy position
  • Trendelenburg position
  • reverse Trendelenburg position
  • lateral decubitus position

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.

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 the pregnant woman much greater freedom in the position which she adopts.

The lithotomy position continues to be employed for various procedures:

  • transperineal prostate biopsies 2

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