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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
legs to either side of the table — to improve access to the abdominal cavity.
Use patient stabilizers, including straps on the legs of patients placed in the
lithotomy position, and foot plates and shoulder pads on patients in the
Trendelenburg and reverse Trendelenburg positions. Patients can shift signifi-
cantly on the table if they're not properly supported in those 2 directions. Also
be aware that patients in deep reverse Trandelenburg have diminished venous
return from the lower extremities, so it's important to have sequential compres-
sion devices working on their legs during these situations.
Constant communication
It's absolutely critical that the OR team discuss room setup and ensure instru-
ments, positioning devices and patients are positioned properly before the case
starts. For example, I've started to use more assistive devices during proce-
dures: camera and instrument holders that attach to the table rail. If your sur-
geon wants to add these useful attachments to the mix, be sure the table can
accommodate them in various positions.
These factors aren't as much of an issue in ORs where staff are familiar with
surgeons' preferences or in facilities where fixed teams work with specific docs.
But in many facilities where teams work in numerous ORs and shifts change in
the middle of the day or case, ensuring the room is properly set up can be a chal-
lenge.
T A B L E S
er in order to keep their arms close to parallel and avoid having their hands posi-
tioned near their shoulders.
Changing the orientation of the table during laparoscopic cases is also very
useful. Moving it away from the anesthesia machine and at a 45-degree angle to
the anesthesia provider lets the surgical team place towers and monitors near
the patient's head, which gives surgeons straight-on views of the monitors — an
ideal arrangement for improving ergonomics.
— Ramon Berguer, MD, FACS
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