Lithotomy Position · What Is It and It Uses

The lithotomy position refers to a specific positioning of the body for the purposes of surgical procedures or certain medical examinations. The individual lies in a supine position with the legs abducted at about 30 to 45 degrees from the midline. The examination table is specifically designed to support the hips and knees, which are usually flexed at about 90 degrees using stirrups or boot-like leg holders. The lithotomy position allows better access to certain anatomical locations, like the pelvic and perineal organs.   

The lithotomy position is commonly used during gynecologic, rectal, and urologic examinations or surgeries. The positioning facilitates access to specific anatomical structures, such as the organs of the urinary and reproductive system as well as the rectum and anus. For example, the lithotomy position is the preferred position for childbirth, gynecological examination, pap smear or vaginal ultrasound.  

Additionally, lithotomy is a common position selected in urethral surgeries, colon surgeries, and removal of bladder stones. The surgical removal of rectal or prostate tumors may also be performed in the lithotomy position.  

When positioned on the examination table for a long time, especially when positioning exceeds 2 hours, caution should be taken regarding possible consequences.  

Nerve compression, especially of the femoral nerve or the common peroneal nerve, is the most common side effect of the lithotomy position. Injury of the peroneal nerve may occur as the peroneal nerve is positioned around the head of the fibula, which rests against the leg support while in the lithotomy position. Therefore, lower extremity padding is typically used in order to prevent nerve injury. Improper positioning or inadequate padding can result in peroneal nerve palsy, manifesting as foot drop or sensory disturbances. To reduce this risk, caution should be taken at the positioning of the legs with adequate padding of the lower extremities and stirrups to prevent any muscular injury or inadequate perfusion of the lower extremities, especially in prolonged procedures. This may also lead to acute compartment syndrome of the lower extremities. Risk factors associated with compartment syndrome are related to venous obstruction in the lower extremities and may include leg fixation or elevation of the legs above the level of the heart for a long period of time. 

In addition, hemodynamic changes (i.e., increase of venous return to the heart and consequently increased cardiac output) may occur if the examination table is positioned at an angle with the feet elevated above the head (i.e., Trendelenburg position). This positioning during prolonged surgeries and in individuals with multiple comorbidities, especially of the cardiovascular system, may cause pulmonary edema and exhaustion of the heart muscle.