The patient's hips and knees are flexed, and the patient's feet are placed in stirrups to gain ready access to the genitalia and perineum. The range of flexion may be modest (low lithotomy) or extreme (high lithotomy). The feet may be suspended on vertical structures known as candy canes or in boots, or the knees may be supported with crutches. With elevation of the legs, pressure is taken off the lower back, and blood is translocated from the lower extremities to the central compartments.
Compression to lower extremity peripheral nerves is the most common injury, occurring in about 1% to 2% of patients placed in the lithotomy position. Neuropathies may be unilateral or bilateral and are a function of the time in this position (especially longer than 2 hours).
They are noted soon after surgery, may present with paresthesias and/or motor weakness, and usually resolve completely, although this may require a few months. Before these injuries are attributed to lithotomy positioning, consider if use of neuraxial needles, lower extremity tourniquets, or surgical trauma (e.g., use of retractors) may have contributed.
To prevent dislocation of the hips, at case conclusion both feet should be released from the lithotomy stirrups and lowered simultaneously. When the leg section of the operating table is elevated, ensure that the fingers are clear to avoid crush or amputation injuries.
Was this article helpful?
This guide will help millions of people understand this condition so that they can take control of their lives and make informed decisions. The ebook covers information on a vast number of different types of neuropathy. In addition, it will be a useful resource for their families, caregivers, and health care providers.