Sliding Versus Shifting during Pelvic Laparoscopic Procedures

Abstract

<h3>Study Objective</h3> To introduce the concept of body shifting as encountered during laparoscopic procedures in Trendelenburg position. To explain how to differentiate between sliding and shifting. To discuss potential consequences of body position changes in Trendelenburg position and to propose risk mitigating strategies. <h3>Design</h3> Surgical case video. Body position changes during entering and recovering from Trendelenburg position are demonstrated. Presentation is enhanced with diagrams. <h3>Setting</h3> Robotic pelvic surgery in morbidly obese patient. <h3>Patients or Participants</h3> The concept is presented on the example of single case. <h3>Interventions</h3> Visual assessment and marking of the position of patient's head during entering and leaving Trendelenburg position. <h3>Measurements and Main Results</h3> Obese patients in Trendelenburg position act as multilayer object. Observed changes in position are result of both sliding and shifting. In demonstrated case, the effect of shifting (10 cm) was twice more prominent than effect of sliding (5 cm). <h3>Conclusion</h3> Not all changes in patients' relationship to operating table in Trendelenburg position are result of sliding. Recognition and documentation of body shifting is important, as it results from patient's body intrinsic characteristics and is largely not preventable, which is in sharp contrast to sliding. Both sliding and shifting may result in displacement of patient's anatomy. In circumstances of legs being locked in stirrups, cephalad body displacement may result in nerves' stretch injuries. In circumstances of sliding or shifting, after settling in Trendelenburg position, confirmation of absence of cephalad tension on legs, may be considered. More research is needed on patient's positioning during laparoscopic cases, as most current recommendations are based on level III evidence.