tion, the patient's spine must be properly aligned, the hips placed at 90
degrees and the shoulder, hips and face protected from skin and
nerve damage — all while providing surgeons with unimpeded access
to the surgical site.
When placing patients in the Trendelenburg position for robotic,
colorectal and gynecologic procedures, keeping them stable as they
lie inverted is critical to preventing skin injuries and nerve damage
that can occur if they slide down the table's surface during conven-
tional laparoscopy or port trauma if they move only a matter of inch-
es during robotic surgery (see "The Trouble With Trendelenburg").
Luckily, several positioning attachments offer solutions to these
potential problems. One inflatable device is unfolded onto the surgical
surface and its integrated straps attach securely to the table's rails.
The patient is transferred onto the device, with her arms to the side.
Staff members mold the positioner around her body then deflate it,
forming a vacuum-like seal around the contours of her sides and
shoulders to keep them padded and securely in place on the table's
surface throughout the procedure. The same technology is available
for patients positioned laterally. Another option involves placing a
shape-conforming single-use pad on the table's surface that molds to
the contours of the patient's body, padding her shoulders and hips.
The pad keeps the patient from sliding and, hopefully, eliminates the
need to reposition her mid-procedure.
Accessory advice
Ask surgeons and staff for input when shopping the options for each
type of case you host, from abdominal surgery to orthopedic proce-
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Journal study. Instead, they note, it's preferred to use adequate amounts of appro-
priately placed padding and other methods to prevent sliding and to minimize the
degree of Trendelenburg position. — Daniel Cook
