The lithotomy position is a specialized medical posture where the patient lies on their back (supine) with their legs elevated and supported. This positioning involves flexing the patient’s hips and knees while the legs are spread apart, or abducted, to provide an unimpeded view and physical access to the perineum, pelvis, and lower abdomen. It is a fundamental technique in various medical settings, from routine examinations to complex surgical procedures. The position is named for the ancient surgical procedure of lithotomy, which was the removal of bladder stones through the perineum.
Defining the Position and Patient Setup
Achieving the lithotomy position requires a medical table outfitted with specialized equipment to hold the patient’s lower extremities. The patient’s hips are typically flexed to an angle of 80 to 100 degrees, while their knees are bent, often at a similar angle, to bring the feet up toward the torso. The legs are also abducted, or spread outward, usually to about 30 degrees from the midline, opening the surgical field.
The legs are supported by devices like stirrups or padded boot-style holders attached to the operating table. Stirrups are designed to prevent excessive pressure on the calves and ankles. To prevent injury to the patient’s joints and spine, medical staff must raise and lower both legs simultaneously and symmetrically.
Different surgical requirements necessitate variations of this position, which are defined by the degree of hip flexion. For instance, a “low lithotomy” may involve 40 to 60 degrees of hip flexion for minimal access, while a “high lithotomy” can involve 110 to 120 degrees of flexion for deeper pelvic access. Proper padding is placed at all points of contact, especially where nerves pass close to the skin, to distribute pressure evenly.
Primary Medical Applications
The primary purpose of the lithotomy position is to provide medical professionals with optimal visual and physical access to the perineal and pelvic regions, which are otherwise difficult to reach. This makes it an indispensable position across multiple disciplines. It is widely used in gynecological procedures, including routine pelvic examinations, cervical biopsies, hysterectomies, and dilation and curettage (D&C).
In urology, the position is necessary for procedures that involve the bladder, urethra, and prostate gland, such as cystoscopy and transurethral resection of the prostate (TURP). Colorectal surgery also relies on the lithotomy position for operations like hemorrhoidectomy, anal fistula repair, and certain colon resections, as it exposes the anal and rectal areas.
Obstetrics represents another significant field utilizing this position, particularly during childbirth, although its use is often debated. It provides the medical team with clear access for instrumental deliveries, episiotomy repair, and managing complications. The ability to expose the perineum and lower abdomen simultaneously is a major advantage for procedures that span both anatomical areas, such as laparoscopic gynecological surgeries.
Potential Risks and Patient Safety
Prolonged time in the lithotomy position carries specific risks related to nerve compression and circulatory changes, requiring careful patient monitoring. The most frequent neurological complication involves the common peroneal nerve, which wraps around the head of the fibula near the knee. Compression or stretching of this nerve against the stirrups or support equipment can lead to a condition known as foot drop, resulting in difficulty lifting the front part of the foot.
Another serious, though less common, complication is compartment syndrome in the lower leg, characterized by a rise in pressure within the muscle compartments. This pressure increase can compromise blood flow, leading to tissue damage, and is highly associated with procedures lasting longer than two to four hours. The elevation of the legs above the heart, combined with external pressure from the leg supports, can impair perfusion and venous return, contributing to this risk.
To mitigate these risks, safety protocols emphasize strict attention to padding around bony prominences, particularly the fibular head, and avoiding extreme hip flexion and abduction. For lengthy procedures, medical staff will often limit the duration in the lithotomy position, sometimes repositioning the patient’s legs periodically to restore circulation.