Severe leg compartment syndrome associated with dorsal lithotomy position during radical hysterectomy

2006 ◽  
Vol 32 (6) ◽  
pp. 610-612 ◽  
Author(s):  
Shintaro Yanazume ◽  
Yumi Yanazume ◽  
Ichiro Iwamoto ◽  
Takahiro Tsuji ◽  
Mitsuhiro Yoshinaga ◽  
...  
2000 ◽  
Vol 33 (8) ◽  
pp. 1549-1553
Author(s):  
Tomoaki Karube ◽  
Yasuhisa Abe ◽  
Kenichi Saigou ◽  
Hiromiti Aoyama ◽  
Hiroyuki Hirasawa ◽  
...  

2020 ◽  
Author(s):  
Daniel M. Breitkopf

Abstract Background: Patients with elevated BMI pose a number of challenges for the gynecologist. Pelvic examination may be more difficult due to adiposity in the perineum and labia, increasing the distance between the vulva and cervix. The objective of the current work was to describe use of the lateral decubitus position to improve visualization of the cervix in women with severe obesity. Methods: From 7/1/2010 until 1/31/2020, all records of patients with obesity and unsuccessful cervical visualization during pelvic exam in the dorsal lithotomy position in the author’s clinical practice were reviewed after obtaining Mayo Clinic Institutional Review Board approval. For the lateral decubitus position, the patient was asked to lie on her side on the exam table, facing away from the examiner with knees bent. An assistant elevated the upper bent leg 45 degrees from horizontal, exposing the perineum. A vaginal speculum was then placed in the vagina with the posterior blade toward the anus. The speculum was opened gently as would be done with examination in dorsal lithotomy position until the cervix was visualized.Results: Eleven patients with severe obesity in the gynecologic practice of the author with prior unsuccessful cervical visualization in dorsal lithotomy position were examined in the lateral decubitus position. In all but one case the cervix was successfully visualized in the lateral decubitus position and all intended intrauterine procedures were successfully performed. Conclusions: The use of the lateral decubitus position appears to improve visualization of the cervix in the outpatient setting among women with severe obesity. Consideration should be given to use of the lateral decubitus position when the cervix cannot be visualized in the dorsal lithotomy position.Trial registration: not applicable


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel M. Breitkopf

Abstract Background Patients with elevated BMI pose a number of challenges for the gynecologist. Pelvic examination may be more difficult due to adiposity in the perineum and labia, increasing the distance between the vulva and cervix. The objective of the current work was to describe use of the lateral decubitus position to improve visualization of the cervix in women with severe obesity. Methods A case series was collected. From 7/1/2010 until 1/31/2020, all records of patients with obesity and unsuccessful cervical visualization during pelvic exam in the dorsal lithotomy position in the author’s clinical practice were reviewed after obtaining Mayo Clinic Institutional Review Board approval. For the lateral decubitus position, the patient was asked to lie on her side on the exam table, facing away from the examiner with knees bent. An assistant elevated the upper bent leg 45 degrees from horizontal, exposing the perineum. A vaginal speculum was then placed in the vagina with the posterior blade toward the anus. The speculum was opened gently as would be done with examination in dorsal lithotomy position until the cervix was visualized. Results Eleven patients with severe obesity in the gynecologic practice of the author with prior unsuccessful cervical visualization in dorsal lithotomy position were examined in the lateral decubitus position. In all but one case the cervix was successfully visualized in the lateral decubitus position and all intended intrauterine procedures were successfully performed. Conclusions In this case series, the use of the lateral decubitus position appears to improve visualization of the cervix in the outpatient setting among women with severe obesity. Consideration should be given to use of the lateral decubitus position when the cervix cannot be visualized in the dorsal lithotomy position.


Swiss Surgery ◽  
2002 ◽  
Vol 8 (4) ◽  
pp. 193-196 ◽  
Author(s):  
Christodoulou ◽  
Garofalo ◽  
Echeverri ◽  
Pelet ◽  
Mouhsine

Le syndrome de loge sur positionnement prolongé en lithotomie ou en hémilithitomie, est une complication rare en chirurgie. Les dommages neurovasculaires sont souvent permanents. On reporte deux cas d'ostéosynthèse du fémur en position d'hemilithotomie, compliqués d'un syndrome de loge de la jambe controlatérale. Une revue de la littérature sur les 40 cas décrits, jusqu'à ce jour, nous démontre que cette complication est fortement liée au positionnement du patient et à la durée opératoire. Compte tenu du pronostic fonctionnel incertain, une limitation du temps de positionnement en lithotomie doit être recherchée. La surveillance postopératoire doit être rigoureuse et sans hésitation quant à une fasciotomie éventuelle sur simple examen clinique ou après la mesure de la pression dans les loges. Une technique de positionnement sur la table orthopédique est proposée.


2008 ◽  
Vol 57 (1) ◽  
pp. 21-26
Author(s):  
Ryodai Kawabata ◽  
Hideyuki Kawabata ◽  
Yoshiyuki Masuda ◽  
Setsuro Komiya ◽  
Shinji Yoshino ◽  
...  

Urology ◽  
1994 ◽  
Vol 43 (5) ◽  
pp. 746-747 ◽  
Author(s):  
T.A. Moses ◽  
Karl J. Kreder ◽  
J. Brantley Thrasher

2021 ◽  
Author(s):  
Inés Laso-García ◽  
Fernando Arias-Fúnez ◽  
Gemma Duque-Ruiz ◽  
David Díaz-Pérez ◽  
Alberto Artiles-Medina ◽  
...  

The incidence of urolithiasis is progressively increasing worldwide, as is the surgical treatment of urinary stones. The most frequent surgery for urolithiasis is ureterorenoscopy, which is performed in the lithotomy position. This position is also used in the endoscopic approach to bladder stones. Lateral decubitus is rarely used in the treatment of urinary stones. In the case of complex kidney stones, the gold standard treatment is percutaneous nephrolithotomy. This surgery has traditionally been performed in the prone position. However, the use of the supine (Valdivia) position is increasing in recent times. Furthermore, the Galdakao-modified supine Valdivia position has been widely used for percutaneous nephrolithotomy since it was described by Ibarluzea et al. in 2007. Treatment of kidney and ureteral stones simultaneously is allowed in both supine positions. In addition, they allow the removal of encrusted stents and the easy placement of double J stents and, in the case of the Galdakao-modified supine Valdivia position, percutaneous nephrostomies. Compartment syndrome is a rare complication in the lithotomy position, but scarcely described in the supine position. This especially applies to the Galdakao-modified supine Valdivia position, in which the lower limbs are in moderate flexion, with the ipsilateral lower limb in a slightly lower position relative to the other. This complication can lead to skin necrosis, myoglobinuric renal failure, amputation, permanent neuromuscular dysfunction, and even death. Risk factors include Body Mass Index, male gender, obesity, increased muscle mass, peripheral vascular disease (advanced age, hypertension, hyperlipidemia and diabetes mellitus), height, lack of operative experience, significant bleeding during surgery, hypothermia, acidemia, combination general-spinal anesthesia, prolonged surgical time, systemic hypotension, ASA (American Society of Anesthesiologists) class or vasoconstrictor drugs. Therefore, compartment syndrome of the leg is a potentially devastating complication that must be suspected and treated through early decompression of the compartment by four compartment fasciotomy. Preventive measures reduce the incidence of this condition.


2019 ◽  
Vol 18 ◽  
Author(s):  
José Maciel Caldas dos Reis ◽  
Lauro José Mendes Queiroz ◽  
Pablo Ferreira Mello ◽  
Renan Kleber Costa Teixeira ◽  
Fábio de Azevedo Gonçalves

Abstract Acute compartment syndrome of the lower extremities after urological surgery in the lithotomy position is a rare but potentially devastating clinical and medicolegal problem. We report the case of a 67-year-old male who underwent laparoscopic prostatectomy surgery to treat cancer, spending 180 minutes in surgery. Postoperatively, the patient developed acute compartment syndrome of both legs, needing emergency bilateral four-compartment fasciotomies, with repeated returns to the operating room for second-look procedures. The patient also exhibited delayed wound closure. He regained full function within 6 months, returning to unimpaired baseline activity levels. This report aims to highlight the importance of preoperative awareness of this severe complication which, in conjunction with early recognition and immediate surgical management, may mitigate long-term adverse sequelae and improve postoperative outcomes.


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