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O R
T A B L E S
head.
Uphill battles
The advent of robotics in outpatient surgery, along with the prevalence of gynecological, urological, colorectal and cholecystectomy
surgeries, means patients are spending more time in the
Trendelenburg position, which can present a range of positioning
challenges and hazards.
You'll want to avoid, for example, discharging your patients with —
or having them discover later — the "burns" that result from sliding
skin and the shear force created when patients are pulled up or down
with sheets. Not only do they look as bad as electrocautery burns, but
also they can increase and prolong post-op pain.
Robotics presents some ghastly technological hazards. As one manufacturer puts it, "the robot is not programmed to compensate for
changes in patient location on the OR table. When a patient slides
'just a little bit,' the arms/trocars of the robot will begin to assume the
primary role for restraining the patient."
To prevent sliding, Medicus Surgical offers a system that uses the
concavities of the anatomy to hold patients in place. Along with a
head-stabilizing speed bump, the company's attachments include lateral torso-stabilizing pillows that prevent the torso from shifting. The
combination of patient weight and gravity keep the thoracic spine in
direct contact with the foam bolster, so the steeper the tilt, the more
firmly patients are held, even those who weigh up to 450 pounds.
As an adjunct, foam guards can also be used to hold arms in place,
providing cushioning that protects against pressure and nerve injuries
and provides anesthesia access via a zipper-like closure.
Another option for safely and comfortably holding patients in
Trendelenburg (as well as in reverse Trendelenburg and the lateral
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | N O V E M B E R 2013
