The lithotomy position is a medical term referring to a common position for surgical procedures and medical examinations involving the pelvis and lower abdomen, as well as a common position for childbirth in Western nations. The lithotomy position involves the positioning of an individual's feet above or at the same level as the hips (often in stirrups), with the perineum

Perineum

In human anatomy, the perineum is a region of the body including the perineal body and surrounding structures...

 positioned at the edge of an examination table. References to the position have been found in some of the oldest known medical documents including versions of the Hippocratic oath

Hippocratic Oath

The Hippocratic Oath is an oath historically taken by physicians and other healthcare professionals swearing to practice medicine ethically. It is widely believed to have been written by Hippocrates, often regarded as the father of western medicine, or by one of his students. The oath is written in...

 (see lithotomy

Lithotomy

Lithotomy from Greek for "lithos" and "tomos" , is a surgical method for removal of calculi, stones formed inside certain hollow organs, such as the kidneys , bladder , and gallbladder , that cannot exit naturally through the urinary system or biliary tract...

); the position is named after the ancient surgical procedure for removing kidney stones, gall stones and bladder stones via the perineum

Perineum

In human anatomy, the perineum is a region of the body including the perineal body and surrounding structures...

. The position is perhaps most recognizable as the 'often used' position for childbirth: the patient is laid on the back with knees bent, positioned above the hips, and spread apart through the use of stirrup

Stirrup

A stirrup is a light frame or ring that holds the foot of a rider, attached to the saddle by a strap, often called a stirrup leather. Stirrups are usually paired and are used to aid in mounting and as a support while using a riding animal...

s.

The position is frequently used and has many obvious benefits from the doctor's perspective. Most notably the position provides good visual and physical access to the perineal region. The position is used for procedures ranging from simple pelvic exams to surgeries and procedures involving, but not limited to reproductive organs, urology, and gastrointestinal systems. New observations and scientific findings, combined with a greater sensitivity to patient needs have raised awareness of the physical and psychological risks the position may pose for prolonged surgical procedures, pelvic examinations, and, most notably, childbirth.

Lithotomy position, prolonged surgical procedures and circulatory complications

Some studies have found a significant relationship between prolonged surgical procedures with the patient in the lithotomy position and a circulatory complication known as "compartment syndrome

Compartment syndrome

Compartment syndrome is a limb threatening and life threatening condition, defined as the compression of nerves, blood vessels, and muscle inside a closed space within the body . This leads to tissue death from lack of oxygenation due to the blood vessels being compressed by the raised pressure...

", "...a condition in which increased tissue pressure within a limited tissue space compromises the circulation and function of the contents of the space." Nerve injury by pressure is also possible, the femoral or peroneal nerve are at risk.

Lithotomy position and pelvic exams

Patients have reported feeling a loss of control and increased sense of vulnerability when examined in the lithotomy position because they cannot see the area being examined. Other, equally effective positions have been suggested for examinations of conscious patients.

External links

• Lithotomy Position. Information and research on the use of the Lithotomy Position in Childbirth
• Effect Of Lithotomy Position On Spinal Anesthesia