Importance of proper positioning in surgery
Proper positioning during surgery is crucial for a successful outcome and patient safety. The position of the patient can affect several factors, including the surgeon's ability to access the surgical site, the patient's comfort and safety, and the effectiveness of anesthesia and ventilation. One of the four main surgical patient positions is the lateral position.
What is the Lateral Position？
The lateral position refers to one of the ways an individual can lie on a surgical table in the operating room during a procedure. In lateral positioning, the person lies on their left or right side with the operative side up. The patient's head is usually supported with a pillow, and the body is secured in place with straps or pads to prevent movement during the surgery. The lateral position allows the surgeon to access certain organs or body parts more easily, and can also provide better ventilation and oxygenation during surgery. However, it is important to ensure that the patient is properly prepared and monitored during the procedure to prevent potential risks and complications.
Why Would You Place a Patient on the Left Side or Right Side?
Depending on the side of the body on which the patient is being operated, the patient will lie on their left or right side.
Right Lateral Position
The right lateral position is used in operations where the doctor or surgeon needs access to the left side of the patient's body. Therefore, the patient would be placed on their right side with the left side of the body facing up.
Left Lateral Position
The opposite of the right lateral position, the left lateral position is used in operations where the doctor or surgeon needs access to the right side of the patient's body. Therefore, the patient would be placed on their left side with the right side of the body facing up.
When to use Lateral Position?
The lateral position is a commonly used position in various surgical procedures. Here are some types of surgeries that may use the lateral position:
* Kidney Surgery: The lateral position is commonly used in kidney surgery, such as a nephrectomy or partial nephrectomy. This position allows the surgeon to access the kidney from the side, making it easier to see and work on the surgical site. It also helps minimize the risk of injury to the surrounding organs, such as the liver and spleen.
* Hip Surgery: The lateral position may be used in hip surgery, such as a total hip replacement or hip arthroscopy. This position provides optimal exposure to the hip joint, allowing the surgeon to access and repair the damaged tissue. It also helps minimize the risk of dislocation during the procedure.
* Spinal Surgery: The lateral position may also be used in spinal surgery, such as a lumbar discectomy or spinal fusion. This position allows the surgeon to access the spine from the side, providing a clear view of the surgical site. It also helps minimize the risk of damage to the spinal cord and nerves.
* Thoracic Surgery: The lateral position may be used in thoracic surgery, such as a thoracotomy or lung resection. This position allows the surgeon to access the chest cavity from the side, providing optimal exposure to the surgical site. It also helps minimize the risk of injury to the heart and lungs.
* Vascular Surgery: The lateral position may also be used in vascular surgery, such as a femoral artery bypass or aortoiliac reconstruction. This position provides optimal exposure to the surgical site, allowing the surgeon to access and repair the damaged blood vessels. It also helps minimize the risk of injury to the surrounding organs, such as the bladder and intestines.
These are just a few examples of the types of surgeries that may use the lateral position. The decision to use this position will depend on several factors, including the type of procedure being performed, the patient's medical history and physical condition, and the surgeon's preference and experience.
Lateral Position Supporting Devices
There are several types of padding and positioning devices commonly used to support patients in a lateral position. These devices help prevent pressure ulcers and maintain proper alignment of the spine, hips, and other joints. Some of the most common types of lateral position devices are:
* Horseshoe Head positioner – This headrest can be used to support the patient’s head in both supine and lateral positions. It can help reduce the risks of ocular pressure by offloading the area.
* Multi-Posture Armboard – The padded arm support constructed of lightweight carbon fiber provides versatile positioning for lateral, supine, prone, and seated patient postures. This arm board provides appropriate alignment of arms in the lateral position.
* Lateral Positioner – This positioner permits a safe, quick, and easy transition from the supine position to the lateral position. The patient’s lower shoulder fits into the integral channel to provide exceptional patient comfort and nerve protection while in the lateral position. The built-in headrest and axillary support assist in proper spinal alignment and surgical site access.
* Tunnel Pad – The patient’s dependent leg should be flexed at the hip and knee, the upper leg should be straight and supported with an approved positioner between the legs, dependent knee, ankle, and foot should be padded.
* Positioning belts: These are used to keep the patient in a lateral position and prevent them from rolling onto their back or stomach.
Complications associated with lateral position
A. Respiratory Complications: Difficulty with breathing due to the pressure exerted on the lungs, especially in obese or pregnant patients
B. Cardiovascular Complications: Decreased venous return due to the effects of gravity, leading to decreased cardiac output and hypotension
C. Nerve Damage: Peripheral nerve damage due to pressure on the nerves in the arms or legs
D. Eye Injuries: Ocular injuries due to compression of the globe, or injury from the anesthesia mask during surgery
E. Patient Falls or Movement During Surgery: Increased risk of patient falls or movement during surgery due to awkward positioning or inadequate restraint
It's important for healthcare providers to be aware of these potential risks and take appropriate precautions to minimize them when using lateral positioning during surgery. Close monitoring of the patient and proper patient selection are key factors in reducing the risk of complications associated with lateral positioning.
Conclusion
In summary, lateral positioning is an effective technique for improving surgical access, visualization, and instrument maneuverability during surgical procedures. Proper patient positioning is essential for achieving optimal surgical outcomes, as it can minimize the risk of complications and improve patient safety. However, there are potential risks associated with lateral positioning, such as respiratory and cardiovascular complications, nerve damage, eye injuries, and patient falls. Therefore, healthcare providers must prioritize patient safety and take appropriate precautions to minimize these risks. We urge all healthcare providers to remain vigilant about patient positioning and safety and to continue seeking out ways to improve the quality and safety of surgical care.
Related Resources
Reference
Welch, M. B. (n.d.). Patient positioning for surgery and anesthesia in adults. UptoDate . Retrieved June 27, 2022
Rothrock, J. C. (2011). Alexander's care of the patient in surgery (14th ed.). St. Louis, MO: Mosby.
