Intraoperative pressure monitoring of the lower leg for preventing compression-related complications associated with the lithotomy position

Kajitani, Ryuji; Minami, Maiko; Kubo, Yuka; Iwaihara, Haruka; Takishita, Yurie; Isayama, Mie; Ohno, Ryo; Hayashi, Takaomi; Sasaki, Takahide; Matsumoto, Yoshiko; Nagano, Hideki; Komono, Akira; Aisu, Naoya; Yoshimatsu, Gumpei; Yoshida, Yoichiro; Hasegawa, Suguru

doi:10.1007/s00464-021-08921-0

Cited by 6 publications

(6 citation statements)

References 17 publications

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“…The present study assessed the incidence of DTI in patients who underwent surgery in the lithotomy position as well as determining the factors associated with DTI in this population. Evaluation of pressure in the lithotomy position showed that pressure was significantly higher on the proximal calf than on other parts of the body, with pressure exceeding 50 mmHg being associated with obesity and elevation of the lower limb above 60 degrees [ 9 ]. Although the present study also found that high BMI was a risk factor for DTI, the calculated cutoff values were not limited to obese individuals, with non-thin patients considered to be at uniform risk of developing DTI.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Postoperative Risk of Deep Tissue Injury to the Lower Extremities Following Surgery in the Lithotomy Position

Yukizawa,

Kamono,

Takagawa

et al. 2024

Cureus

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Background The aim of this study was to determine the incidence of deep tissue injury (DTI) and potential risk factors after surgery in the lithotomy position. Methods All patients who underwent surgery in the lithotomy position under general anesthesia at a single center between January 2017 and December 2021 were retrospectively evaluated. The medical records of these patients were reviewed, and patient demographic and clinical characteristics, surgical data, and occurrence of DTI were recorded. Results During the study period, 5146 patients, 2055 (39.9%) males and 3091 (60.1%) females, with a mean age of 57.3 ± 17.4 years, underwent surgery in the lithotomy position. Seven (0.14%) patients developed DTI on their calf following surgery. All presented with severe pain and swelling, requiring prolonged hospital stay. Multivariate analysis showed that male sex (odds ratio (OR): 11.43; 95% confidence interval (CI): 1.15-113.34, p = 0.037), higher BMI (OR: 1.32; 95% CI: 1.17-1.50, p = 0.0001), and longer operation time (OR: 1.01; 95% CI: 1.004-1.014, p = 0.0002) were independent risk factors for postoperative DTI. Optimal cut-off values for BMI and operation time were 23.5 kg/m 2 (sensitivity = 100%; specificity = 64%) and 285 minutes (sensitivity = 100%; specificity = 90%), respectively. Conclusion Factors significantly associated with DTI include male sex, higher BMI, and prolonged operation time.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the Postoperative Risk of Deep Tissue Injury to the Lower Extremities Following Surgery in the Lithotomy Position

Yukizawa,

Kamono,

Takagawa

et al. 2024

Cureus

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“…Reduced peripheral blood flow leads to muscle and nerve ischemia [ 11 ]. Hypoperfusion has various causes, including leg elevation during the surgical positioning [ 12 , 13 ], intraoperative hypotension [ 5 ], low circulating blood volume, hypothermia, vasoconstrictors, spinal anesthesia, a history of peripheral vascular disease, and traction of large vessels during surgery [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Well-leg compartment syndrome after laparoscopic low anterior resection in the lithotomy position: a case report and literature review

Nakayama,

Yamaguchi,

Inoue

et al. 2024

Journal of Surgical Case Reports

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Well-leg compartment syndrome (WLCS) develops in healthy lower limbs because of surgical factors such as operative position, lower limb compression, and long operative time during abdominopelvic surgery. WLCS can lead to irreversible muscle and nerve damage if a prompt diagnosis and appropriate treatment are not provided. We report the case of a 57-year-old male who developed rectal cancer immediately after laparoscopic low anterior resection and was successfully treated with fasciotomy without sequelae. Patients who undergo surgery in the lithotomy position for a prolonged period are at risk of WLCS. Therefore, when determining the differential diagnosis of postoperative lower leg pain, it is necessary to consider WLCS because it is a complication caused by the intraoperative position.

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“…Although frequently used in surgical procedures, the lithotomy position carries the potential for various complications, including lower extremity venous thrombosis, nerve damage, and pressure injuries. 3 , 8 , 9 As a result, the use of stirrups is increasingly favored due to their enhanced safety and convenience. 10 Consequently, their application in clinical context is widespread.…”

Section: Discussionmentioning

confidence: 99%

“…These complications may include peroneal nerve injury, deep vein thrombosis in the lower extremities, calf compartment syndrome, pain and numbness, and even motor disorders. 3 , 4 With the advancement of medical technology and the increasing focus on the well-being of surgical patients, the lithotomy position with stirrup support is being used more frequently in clinical practice. 5 The stirrup provides greater comfort to the patient compared to the traditional lithotomy leg support.…”

Section: Introductionmentioning

confidence: 99%

A Randomized Controlled Comparative Study of the Three Over-Bed Techniques for Positioning and Repositioning the Lithotomy Position While Using Stirrups

Zhang,

Luo,

Yang

2023

JMDH

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Objective In this study, the clinical application and efficacy of three different methods for placing and repositioning patients in the lithotomy position over the bed using stirrups were evaluated. Methods A total of 240 surgical patients who underwent surgery in Chongqing Traditional Chinese Medicine Hospital between July and November 2022 were selected as study participants. Using envelopes, they were randomly divided into three groups of 80 cases each using a randomization method. The groups included the traditional over-bed method, the postural trolley-assisted over-bed method, and the direct over-bed method. Using the Kruskal–Wallis rank-sum test, analysis of variance, and multiple linear regression equations, the placement time, over-bed repositioning time, and total time of the three methods for placing and repositioning in the lithotomy position supported by stirrups were analyzed statistically. In addition, we investigated and examined the satisfaction of nurses and doctors with the aforementioned techniques. Results The placement time, repositioning time, and total time were significantly higher for the traditional over-bed method than for the postural trolley-assisted over-bed method and the direct over-bed method (both P < 0.01). However, there was no statistically significant difference between the postural trolley-assisted over-bed method and the direct over-bed method ( P > 0.05). Nurses and doctors reported significantly higher satisfaction with the postural trolley-assisted over-bed method and the direct over-bed method compared to the traditional over-bed method (both P < 0.01). In addition, nurses were more satisfied with the direct over-bed method than the postural trolley-assisted over-bed method ( P < 0.05). Conclusion The results of this study demonstrate that the direct over-bed method is preferred for positioning and repositioning patients in the lithotomy position with the support of stirrups.

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Intraoperative pressure monitoring of the lower leg for preventing compression-related complications associated with the lithotomy position

Cited by 6 publications

References 17 publications

Evaluation of the Postoperative Risk of Deep Tissue Injury to the Lower Extremities Following Surgery in the Lithotomy Position

Evaluation of the Postoperative Risk of Deep Tissue Injury to the Lower Extremities Following Surgery in the Lithotomy Position

Well-leg compartment syndrome after laparoscopic low anterior resection in the lithotomy position: a case report and literature review

A Randomized Controlled Comparative Study of the Three Over-Bed Techniques for Positioning and Repositioning the Lithotomy Position While Using Stirrups

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