Ingenuity of Intraoperative Lithotomy Position in Patients with Severe Kyphosis

Abstract

The lithotomy position is difficult for patients with severe kyphosis. We report a case of colon cancer in a patient with severe kyphosis, in which an “ultra shoulder positioner” was useful in maintaining the lithotomy position. An 88-year-old woman with severe kyphosis visited our hospital with a chief complaint of constipation from the previous day. Computed tomography showed a sigmoid tumor and dilation of the colon on the oral side of the tumor. The patient was diagnosed with obstructive colitis due to sigmoid colon cancer, and surgery was scheduled after placement of a colorectal stent. Since the supine position was difficult due to severe kyphosis, preoperative positioning simulation was performed. Because a magic bed was not effective, we used an “ultra shoulder positioner,” which made it possible to keep the spine positioned at a reasonable angle. After awake tracheal intubation in the left lateral decubitus position, the patient was repositioned to the supine lithotomy position according to the preoperative simulation. Preoperative positioning simulation was useful to change the position smoothly, and to shorten the operation time, and it eventually prevented the occurrence of postoperative low back pain and pressure ulcers.