Lithotomy position
The lithotomy position ( SSL for short ) is a medical positioning position of the patient used by gynecologists , urologists and proctologists and for which a special examination chair , the gynecological chair , is often used.
Origin of the term
The term comes from historical medicine: In the past, bladder stones were only removed in this position.
Implementation and application
When lithotomy position, the patient lies on his back, which must lie flat. With the help of raised half-shells, the hips can be bent by almost 90 °. The knees are bent and the lower legs are placed on supports with about 100 ° knee flexion. As a preventive measure, the lower legs are padded in order to avoid the effects of pressure damage to the peroneal nerve. The legs are about 50 to 60 ° apart. The spreading of the legs depends on the anatomical and physiological condition of the patient.
Lithotomy position with lowered legs is performed during operations such as laparoscopes and laparotomies. In preparation, attention is paid to the padding of the back in the form of gel and vacuum mats. In the supine position, the padding materials also ensure stability and slip resistance. In the lowered form, the legs are supported by half-shells in a 160 ° knee flexion. In order to better reach the inner genitals, the thighs should be in line with the body ("lowered legs"). In the case of laparoscopies, however, careful handling has priority. H. the thighs should be at an angle of 15 - 20 ° to the body to avoid injuries during the puncture.
Operations on the membranous urethra and the perineal access to the prostate require extreme lithotomy position. With flexion in the lumbar spine , lifting of the rump (inclined positioning cushion) and greater flexion in the hip joint, the perineum can be aligned parallel to the floor. The legs are hung in special brackets. The key is the padding of all relevant pressure points.
The positioning is always useful when the region of the genitourinary system is the target area for an operation. In the case of distal colon and rectal resections, rectal carcinoma can be operated from the lithotomy position as well as via a lower abdominal laparotomy or laparoscopically.
Terminology for localization in the anus
In general surgery, the term lithotomy or SSL is also used to describe the localization of anal fissures or anal abscesses . One looks from the foot at the patient lying on their back and puts a clock in front of oneself: "12 o'clock SSL" means towards the dam , "6 o'clock SSL" means towards the rump .
Complications
Complications from lithotomy position are very rare. It can lead to compartment syndrome of the lower leg, lesions of the femoral nerve or the peroneal nerve . Risk factors are long periods of storage and strong flexion and rotation in the hip joint.
Contraindications
Contraindications for lithotomy position are contractures or hip joint diseases with no possibility of lithotomy position, especially important are flexion and abduction in the hip joint .
Sources and individual references
- ^ Lithotomy position (SSL). In: D. Manski: Textbook of Urology. on-line. (urologielehrbuch.de)
- Margret Liehn, Brigitte Lengersdorf, Lutz Steinmüller, Rüdiger Döhler (eds.): Operating manual: basics, instruments, operating procedure. 6th edition. Springer-Verlag, 2016, ISBN 978-3-662-49280-2 .