You have accessJournal of UrologyStone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (IV)1 Apr 20131986 A NOVEL TECHNIQUE IN PLACEMENT OF THE MORBIDLY OBESE IN LITHOTOMY POSITION Patrick Irwin, Samay Jain, Natalie Singer, Adam Becker, and Khaled Shahrour Patrick IrwinPatrick Irwin Toledo, OH More articles by this author , Samay JainSamay Jain Toledo, OH More articles by this author , Natalie SingerNatalie Singer Toledo, OH More articles by this author , Adam BeckerAdam Becker Toledo, OH More articles by this author , and Khaled ShahrourKhaled Shahrour Toledo, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2405AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is a rising prevalence of morbid obesity in North America with obesity inflicting more than 30% of adults in USA. Moreover, morbid obesity is associated with increased incidence of nephrolithiasis with less successful treatment options. Theoretically, retrograde reno-ureteroscopy is done more frequently in morbidly obese patients as it is the least stone treatment to be adversely affected by morbid obesity. Nevertheless, special instruments, stirrups and operating tables for morbidly obese patients are expensive and may not be available in most operating rooms. We propose a fast and safe method in placing morbidly obese patients in lithotomy position using regular operating room tables. This technique can be used for patients with extensive leg size or weight that cannot be put in stirrups for lithotomy position. METHODS Three operating tables are positioned as in the figure. Once the patient is sedated, the two lower extremity tables (tables 2 and 3) are widened in a lambda formation and then elevated to achieve a modified dorsal lithotomy position. The patient is secured into position on the tables with cloth tape around each leg and the abdomen. Excessive fat can be retracted by cloth tape to improve access to the perineum. The table supporting the patient's trunk is then lowered, placing the patient in mild Trendelenburg position. RESULTS This positioning technique was used in two patients for 3 procedures each. The first patient is a 60-year-old male with symptomatic bilateral stones. He is 185.4 cm tall and weighs 217.7 kg with body mass index (BMI) of 63.3. The second patient is a 58-year-old female with right partial staghorn stone. She is 167.6 cm tall and weighs 225.9 kg (BMI 80.4). Mean positioning time in the 6 procedure was 9.8±3.2 minutes (range is 6-15 minutes). Mean operative time was 167.2±63.1 minutes (range is 84-240 minutes). No intra-operative or post operative adverse events were reported. CONCLUSIONS The three table technique is a fast and practical alternative to the use of expensive large capacity operative tables and stirrups for lithotomy position in patients with morbid obesity or other morbidities that do not allow for safe placement of legs in stirrups. There were no adverse events associated with this positioning technique in morbidly obese patients despite long operative duration due to extensive stone burden. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e815 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick Irwin Toledo, OH More articles by this author Samay Jain Toledo, OH More articles by this author Natalie Singer Toledo, OH More articles by this author Adam Becker Toledo, OH More articles by this author Khaled Shahrour Toledo, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...