A U G U S T 2 0 1 5 O U T P A T I E N TS U R G E R Y. N E T 4 7
Critical start
Patient positioning is a critical variable of surgery, but OR teams exhibit various
levels of expertise in ensuring patients are placed as surgeons prefer. A good
team that's used to doing the same procedures for the same surgeons can posi-
tion patients appropriately, but surgeons must always check to make sure
they're satisfied with the placement of the knee, shoulder or hip before prepping
and draping.
For example, during an ACL repair, the knee must be positioned to allow for
the application of varus and valgus forces to provide surgeons with access to
the lateral meniscus and medial meniscus, and to obtain enough flexion to place
the drill at the correct angle to make the tunnel for the ACL. It's important to
gain a balance between the two. If the force or flexion is off even slightly, a cir-
culating nurse might have to go under the drapes to reposition the patient dur-
ing the procedure, or the surgeon might have to change his preferred technique
to get the optimal angles for placing the tunnel.
Positioning obese patients is a definite challenge. They have more soft tissue,
which adds to the difficulty of using positioning aids to optimize joint access
through larger tissue envelopes. Positioning patients for shoulder procedures is
also inherently difficult. Placing the patient in the beach chair position can pro-
vide better access for rotator cuff repairs, while the lateral position allows for
better traction and improved access to the inferior portion of the glenoid during
labral repairs.
During arthroscopies, rotator cuff and labral repairs, and total shoulder
replacements, surgeons must position the arm and scapula properly in order to
gain adequate exposure of the humerus and glenoid. They must also ensure
that the patient's head is positioned in a way that will avoid the anticipated tra-
jectory of instruments, and that the drape is placed far enough away from the
surgical site as to not interfere with the placement of drill holes and screws.
