A Novel Technique in Placement of the Morbidly Obese in Lithotomy Position
CUA Online Library. Shahrour K. 06/22/13; 31446; UP-67
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Abstract
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INTRODUCTION AND OBJECTIVES: There is a rising prevalence of morbid and extremely-morbid obesity (BMI >50) in North America. Moreover, morbid obesity is associated with increased incidence of nephrolithiasis with less successful treatment options. Theoretically, retrograde reno-ureteroscopy is done more frequently in Extreme-morbidly obese (EMO) patients. Nevertheless, special instruments, stirrups and operating tables for EMO patients are expensive and may not be available in most operating rooms. We propose a fast and safe method in placing EMO patients in lithotomy position using regular operating room tables. This technique can be used for patients with extensive leg size or weight that cannot be put in stirrups for lithotomy position.
METHODS: Three operating tables are positioned as in the figure. Once the patient is sedated, the two lower extremity tables (tables 2 and 3) are widened in a lambda formation and then elevated to achieve a modified dorsal lithotomy position. The patient is secured into position on the tables with cloth tape around each leg. Excessive fat can be retracted by cloth tape and placing patient in mild Trendeleberg position.
RESULTS: This positioning technique was used in 3 patients for 3 procedures each. The first patient is a 60-year-old male with symptomatic bilateral stones. He is 185.4 cm tall and weighs 217.7 kg with body mass index (BMI) of 63.3. The second patient is a 58-year-old female with right partial staghorn stone. She is 167.6 cm tall and weighs 225.9 kg (BMI 80.4). The third patient is a 39-year-old amle with urethral stricture. He weighs 281.4 Kg (BMI 91.6). Mean positioning time in the 8 procedures was 16.3±7.3 minutes (4-25 minutes). Mean operative time was 140.3±44.1 minutes (84-240 minutes). No intra-operative or post operative adverse events were reported.
CONCLUSION: The three table technique is a practical alternative to the use of expensive large capacity operative tables and stirrups for lithotomy position in EMO patients or other morbidities that do not allow for safe placement of legs in stirrups.
METHODS: Three operating tables are positioned as in the figure. Once the patient is sedated, the two lower extremity tables (tables 2 and 3) are widened in a lambda formation and then elevated to achieve a modified dorsal lithotomy position. The patient is secured into position on the tables with cloth tape around each leg. Excessive fat can be retracted by cloth tape and placing patient in mild Trendeleberg position.
RESULTS: This positioning technique was used in 3 patients for 3 procedures each. The first patient is a 60-year-old male with symptomatic bilateral stones. He is 185.4 cm tall and weighs 217.7 kg with body mass index (BMI) of 63.3. The second patient is a 58-year-old female with right partial staghorn stone. She is 167.6 cm tall and weighs 225.9 kg (BMI 80.4). The third patient is a 39-year-old amle with urethral stricture. He weighs 281.4 Kg (BMI 91.6). Mean positioning time in the 8 procedures was 16.3±7.3 minutes (4-25 minutes). Mean operative time was 140.3±44.1 minutes (84-240 minutes). No intra-operative or post operative adverse events were reported.
CONCLUSION: The three table technique is a practical alternative to the use of expensive large capacity operative tables and stirrups for lithotomy position in EMO patients or other morbidities that do not allow for safe placement of legs in stirrups.
INTRODUCTION AND OBJECTIVES: There is a rising prevalence of morbid and extremely-morbid obesity (BMI >50) in North America. Moreover, morbid obesity is associated with increased incidence of nephrolithiasis with less successful treatment options. Theoretically, retrograde reno-ureteroscopy is done more frequently in Extreme-morbidly obese (EMO) patients. Nevertheless, special instruments, stirrups and operating tables for EMO patients are expensive and may not be available in most operating rooms. We propose a fast and safe method in placing EMO patients in lithotomy position using regular operating room tables. This technique can be used for patients with extensive leg size or weight that cannot be put in stirrups for lithotomy position.
METHODS: Three operating tables are positioned as in the figure. Once the patient is sedated, the two lower extremity tables (tables 2 and 3) are widened in a lambda formation and then elevated to achieve a modified dorsal lithotomy position. The patient is secured into position on the tables with cloth tape around each leg. Excessive fat can be retracted by cloth tape and placing patient in mild Trendeleberg position.
RESULTS: This positioning technique was used in 3 patients for 3 procedures each. The first patient is a 60-year-old male with symptomatic bilateral stones. He is 185.4 cm tall and weighs 217.7 kg with body mass index (BMI) of 63.3. The second patient is a 58-year-old female with right partial staghorn stone. She is 167.6 cm tall and weighs 225.9 kg (BMI 80.4). The third patient is a 39-year-old amle with urethral stricture. He weighs 281.4 Kg (BMI 91.6). Mean positioning time in the 8 procedures was 16.3±7.3 minutes (4-25 minutes). Mean operative time was 140.3±44.1 minutes (84-240 minutes). No intra-operative or post operative adverse events were reported.
CONCLUSION: The three table technique is a practical alternative to the use of expensive large capacity operative tables and stirrups for lithotomy position in EMO patients or other morbidities that do not allow for safe placement of legs in stirrups.
METHODS: Three operating tables are positioned as in the figure. Once the patient is sedated, the two lower extremity tables (tables 2 and 3) are widened in a lambda formation and then elevated to achieve a modified dorsal lithotomy position. The patient is secured into position on the tables with cloth tape around each leg. Excessive fat can be retracted by cloth tape and placing patient in mild Trendeleberg position.
RESULTS: This positioning technique was used in 3 patients for 3 procedures each. The first patient is a 60-year-old male with symptomatic bilateral stones. He is 185.4 cm tall and weighs 217.7 kg with body mass index (BMI) of 63.3. The second patient is a 58-year-old female with right partial staghorn stone. She is 167.6 cm tall and weighs 225.9 kg (BMI 80.4). The third patient is a 39-year-old amle with urethral stricture. He weighs 281.4 Kg (BMI 91.6). Mean positioning time in the 8 procedures was 16.3±7.3 minutes (4-25 minutes). Mean operative time was 140.3±44.1 minutes (84-240 minutes). No intra-operative or post operative adverse events were reported.
CONCLUSION: The three table technique is a practical alternative to the use of expensive large capacity operative tables and stirrups for lithotomy position in EMO patients or other morbidities that do not allow for safe placement of legs in stirrups.
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