Operating table modified
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Have you found yourself with big patients who (when they are in a head-down position) are so big and tall that you need to stand on tippy toes and lift your shoulders and arms over a long time? Especially suturing laparoscopically on those patients for a long time can be extremely tiring.
Until a little while ago, I felt I had to chose between “head down” (and operating with sore shoulders because the operating table was so high) or the bed a little lower but no “head down” Trendelenburg position.
Most gynaecological operations these days are done laparoscopically, in Trendelenburg position (15 to 30 degrees head-down position). When we ask for “head down”, very often, we get “pelvis up”. Hence, our shoulders need to get higher. To lower the operating bed to its lowest and a stool to stand on is definitely part of the solution.
There is another little trick that almost none of our trainees seem to have heard of previously and that I learned only recently. It has to do with the operating table and how we can modify it for our purposes.
If the fulcrum of your operating table is near the patient’s head (Figure A), the “head down” button will give you “pelvis up” (Figure B). However, if you slide the operating bed towards the patients head and move the fulcrum towards the patients pelvis (Figure C), you will get true “head down” (Figure D).
Especially in big patients I like to slide the operating table so that the fulcrum comes to lie underneath the patient’s pelvis. However, in one hospital I go to, the operating bed would not slide far enough. Then, I turn the operating table around 180 degrees and make sure that way that the fulcrum comes to lie under the patient’s pelvis.
This little trick plus standing on a high stool will lift you above the level of the patient’s body and makes operating a lot easier and less tiresome.
Next week, we will chat about another tool that I use regularly – the beanbag. It is used in other surgical specialties but very rarely in gynaecological surgery.
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