Patient Positioning

Prior to patient positioning, a 5 to 6 cm Pfannenstiel incision is drawn with a marking pen two fingerbreadths above the symphysis pubis. This will serve as the extraction site. The extraction incision site should be marked prior to positioning and rotating the patient to ensure symmetry and a good cosmetic result.

The patient is placed in a modified flank position at a 45° angle with the operating table, with the ipsilateral flank facing upwards. Two 10 lbl. sandbags are placed behind the patient to maintain the modified flank position. The downside leg is flexed at the knee and separated from the extended upside leg with a pillow. All pressure points on the downside ankle, hip, and knee are well padded. The downside arm is padded and an axillary roll is carefully positioned. The upside arm is placed on a well-padded arm-board, or, alternatively, pillows may be used (Fig. 2). The upper extremities must be positioned such that there is no tension on the brachial plexus. Once the patient is adequately positioned, the table is gently flexed to extend the flank. The patient is secured to the operating table at the level of the shoulders and thighs with 3-inch cloth tape. A surgical blue towel or additional foam pads are placed over these areas to prevent skin irritation or compression injuries from the secured tape. Once the patient is secured to the operating table, the table can be rotated to facilitate exposure during the procedure.

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