Patient Positioning

The operation table is padded with two layers of foam to provide adequate padding and minimize the risk of neuromuscular injury. After induction of anesthesia, placement of Foley catheter, and orogastric tube the patient is placed in semiflank position (15-20° from vertical) for transperitoneal approach or full flank position for retroperitoneal approach with the kidney rest at the level of twelfth rib. Kidney rest is elevated minimally and the table is flexed slightly to increase the space between the rib cage and the iliac crest. The down leg is flexed and the upper leg is placed straight with three or more pillows between the legs oriented at right angles to the legs. Venodynes and stockings are routinely used to prevent deep venous thrombosis. Two arm boards are placed side by side at the level of shoulder with foam padding. A soft foam axillary roll is positioned two fingerbreadths below the axilla to prevent brachial plexopathy. Three or more pillows are placed inline between the upper extremities to support the upper arm. The safety strap is applied over the lower extremities at the level of calves. A cautery pad is strapped on the upper thigh and a 3-inch. wide cloth tape is used to strap the patient from the edge of the table to the opposite edge of the table. The upper torso is stabilized by using 3-in. wide cloth tape from the edge of the table at the level of shoulders and is split into two strips past the elbows and is attached to either side of the arm boards. Care is taken to reposition all electrocardiogram leads, wires, and intravenous lines so that they are not under the patient at any point. A pneumatic warming device may be used on the upper torso to prevent hypothermia (Fig. 2).

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