4 2
S U P P L E M E N T T O O U T P AT 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 | M O N T H 2 0 1 4
the side or into Trendelenburg and reverse Trendelenburg positions — lets grav-
ity do its thing and improves a surgeon's access to targeted anatomy.
However, standard OR tables are limited in their laparoscopic-friendly maneu-
verability. They tend to be heavy and slow, with limited movement and versatili-
ty. Patients are put in stirrups for several lower abdomen procedures, which can
further hamper movement of the table. There's more trouble if you can't posi-
tion table surfaces low enough to give surgeons comfortable access to the
abdominal cavity. In my opinion, widespread improvements in laparoscopic
table design need to match the advancements made in fracture table design for
orthopedics. A similar user-friendly focus has yet to be applied to general sur-
gery tables, but it would be most welcome.
Protect the patient
Managing the table, patient positioning, table attachments, lifts and instrument
aids are critical at the start of the procedure in order to perform procedures
effectively. Why not discuss these things during pre-op huddles or perhaps even
the pre-procedure time out?
The entire surgical team is responsible for ensuring patients remain secure and
safe when adjusting the table mid-procedure. The anesthesiologist typically is the
one who pushes the directional buttons while watching that Mayo stands or side
tables don't interfere, and alerts the OR staff that the table is moving and in
which direction it's being adjusted. It's also critical for surgeons, anesthesia
providers, nurses and techs to communicate about any patient movement that
may occur — an extremity potentially slipping off an armboard or stirrup —
when the surgical surface is adjusted to avoid unintended injury to the patient.
Be sure the surgical team has access to proper and effective patient posi-
tioning aids. I've started using newly designed stirrups that are more easily
adjustable, both vertically and laterally, with good fixation and ease of adjust-
ment, which is especially important in laparoscopy where surgeons are con-
stantly shifting positions throughout procedures — from between patients'
T A B L E S
1403_AbdominalSurgeryGuide_Layout 1 2/24/14 10:36 AM Page 42
