Abstract

INTRODUCTION AND OBJECTIVES: We report a prospective comparison of operative table positioning (i.e. flexion or no flexion) and its effect on outcomes in laparoscopic renal and adrenal surgery. METHODS: 30 consecutive patients undergoing laparoscopic nephrectomy or adrenalectomy by a single surgeon (CPS) were randomized to surgery with (FL) or without (NF) a 45 degree flexion of the operative table. A single surgeon performed all operations with a transperitoneal pure laparoscopic or hand assisted approach. Operative parameters such as ease of bowel mobilization (BM), ease of renal hilar dissection (HD), and overall difficulty of dissection (DD) were recorded on a 10 point Likert scale. Operative (OT), estimated blood loss (EBL), post-operative pain and peri-operative complications were also recorded prospectively. RESULTS: There were 15 and 15 patients in the FL and NF groups respectively. There were no statistically significant differences in BM, HD, DD, OT, EBL, or post-operative pain. The two complications in the FL group which included testicular pain and a minor serosal injury during mobilization of the colon. This serosal injury was repaired laparoscopically without further sequelae. There was one trocar site infection in the NF group. CONCLUSIONS: Although flexion of the operative table during laparoscopic nephrectomy and adrenalectomy has become standard practice, the effects of such positioning on operative time, ease of exposure, post-operative pain and complications has not been previously defined. Our prospective comparison suggests that there is no benefit to table flexion during laparoscopic renal and adrenal surgery. Surgical exposure, dissection and outcomes do not appear to be affected by patient positioning in this series

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