A hysterectomy is the surgical removal of the uterus, also known as the womb. This common gynecological operation addresses abnormal bleeding, fibroids, or certain cancers. Precise patient positioning is fundamental to the surgical process.
The Standard Surgical Position
For many hysterectomy procedures, the patient is placed in a modified dorsal lithotomy position. This position involves lying on the back with legs raised and supported in specialized stirrups. The hips are typically flexed at about 90 degrees, and knees are bent between 70 to 90 degrees. Boot-type or candy cane stirrups commonly support the lower extremities.
This position provides the surgical team with optimal access to the pelvic and perineal areas. The patient’s arms are usually tucked securely at their sides or extended on padded armboards. Proper alignment of the head and neck is maintained to ensure comfort and safety throughout the operation.
Positioning for Different Surgical Approaches
Patient positioning adapts to the specific surgical approach. For an abdominal hysterectomy, the patient is primarily in a supine position. This provides direct access to the uterus through the abdominal wall.
In contrast, vaginal hysterectomies typically require a high dorsal lithotomy position, with the patient’s buttocks close to the edge of the operating table. For laparoscopic or robotic-assisted hysterectomies, the dorsal lithotomy position often combines with a Trendelenburg tilt. In this position, the patient’s head angles downward, and feet elevate above the head. This head-down inclination uses gravity to shift abdominal organs, such as the bowels, away from the pelvis, enhancing the surgeon’s view and access. The tilt degree can range from approximately 20 to 45 degrees.
Importance of Surgical Positioning
Precise patient positioning is fundamental for surgical effectiveness and patient well-being. It provides the surgeon with clear visualization and unimpeded access to the uterus and surrounding pelvic structures. This optimized surgical field allows for efficient completion of the procedure.
Careful positioning also helps minimize potential complications. Proper padding and support of pressure points, along with avoiding extreme flexion or abduction of joints, can mitigate the risk of nerve damage. It also helps prevent pressure sores and compartment syndrome from prolonged pressure. Attention to positioning safeguards the patient and facilitates a successful surgical outcome.
Patient Preparation for Positioning
Before a hysterectomy, the medical team prepares the patient for positioning. General anesthesia is typically administered, ensuring the patient is asleep and comfortable before being moved into the surgical position. Regional anesthesia may also be used in some instances.
Once anesthetized, careful attention is given to padding all potential pressure points, including the heels, sacrum, elbows, and the head and neck. This padding distributes pressure evenly and helps prevent skin injury. The patient is then secured on the operating table using straps and anti-skid measures, such as foam mattresses, to prevent movement, especially when the table is tilted into the Trendelenburg position.
Both legs are raised and lowered simultaneously to avoid strain or injury to the hips and spine. A Foley catheter is often inserted to drain the bladder, and sequential compression devices or stockings are applied to the legs to help prevent blood clots.