Traditional Supine Position Research Articles

Effect of cervical pillow in phacoemulsification surgery for age-related cataract patients: a prospective randomized controlled study.

To explore the application effect of cervical pillow in phacoemulsification surgery for age-related cataract patients. 104 cases of age-related cataract patients admitted to our hospital in June 2023 were enrolled and divided into the control group (traditional supine position) and the experimental group (the cervical pillow supine position) by the digital parity method (52 cases per group). The two groups were evaluated for the discomfort score, the satisfaction of patients and doctors, the head displacement rate, the number of displacement, the operation time and the time of body position during the operation and after the operation. There was no significant difference in the gender (P = 0.84), age (P = 0.86), course of disease (P = 0.82) and the time spent on position placement (P = 0.15) of the two groups. The patient in the experimental group had lower discomfort score (P = 0.0001), higher patients satisfaction (P = 0.0001) and higher doctors satisfaction (P = 0.0001) than patients in the control group. There was no significant difference between the experimental group and the control group in the proportion of intraoperative (P = 0.36) and postoperative pain (P = 0.65). Besides, the number of head transfers (P = 0.001), number of head shifts (P = 0.0001), the surgical time (P = 0.0001) and laparoscopic time (P = 0.0001) in the experimental group were significantly lower than those in the control group. The additional cervical pillow for age-related cataract patients in the traditional supine position during the operation will not increase the preparation time before the operation, but will help improve the patient satisfaction, improve the comfort and maintain a good position of the operative eye field, bringing obvious comfort and smooth operation for the surgeon in the operation, thus reducing the risk of the operation, shortening the operation time.

Early Prone Position Ventilation in the Efficacy for Severe Hypoxemia and Neurological Complications Following Acute Type A Aortic Dissection (TAAD) Surgery

Objective To analyze the efficacy of early prone position ventilation in the treatment of severe hypoxemia after surgery for acute type A aortic dissection (TAAD). Methods The patients were divided into a control group and a treatment group. Parameters assessed included blood gas analysis indicators [arterial oxygen partial pressure (PaO2). Results: (1) Blood gas analysis: Before treatment, there was no significant difference in PaO2, SpO2, and OI levels between the two groups; after treatment, the PaO2, SpO2, and OI levels in both groups significantly increased compared to pre-treatment, with a more pronounced improvement in the treatment group than in the control group (p < 0.05). (2) Hemodynamics: Before treatment, there was no significant difference in MAP and HR levels between the two groups; after treatment, the MAP levels increased significantly in both groups compared to pre-treatment, while HR levels decreased significantly, with no significant difference between the groups. (3) Prognosis recovery: MV time, ICU stay, and total hospital stay were significantly lower in the treatment group than in the control group; the 30-day mortality rate was 14.58% in the control group and 12.50% in the treatment group, with no significant difference in 30-day mortality rate between the groups. Conclusion Early prone position ventilation has shown promising application in the treatment of severe hypoxemia after TAAD surgery. Compared to traditional supine position ventilation, the use of early prone position ventilation can further improve blood gas analysis indicators in patients, and shorten MV time, ICU stay, and total hospital stay, thereby accelerating patient recovery.

After the Knife: A Detailed Roadmap for Vestibular Schwannoma Resection in the Semi-Sitting Position – How I do it

Vestibular schwannoma surgery remains a neurosurgical challenge, with known risks, dependent on a number of factors, from patient selection to surgical experience of the team. The semi-sitting position has gained popularity as an alternative to the traditional supine position for vestibular schwannoma resection due to potential advantages such as improved surgical exposure due to clearer surgical field and anatomical orientation. However, there is a lack of standardized protocols for performing the procedure in the semi-sitting position, leading to variations in surgical techniques and outcomes. In this study, we aimed to establish a standardized approach for vestibular schwannoma resection using the semi-sitting position. Initiating after final position for semi-sitting, the authors have divided the surgical steps into five major parts for improved understanding and replication. Surgical techniques were analyzed through one hundred steps to identify commonalities, determining the optimal procedural steps for the semi-sitting position using surgical video for visual conceptualization. The analysis described one hundred steps for vestibular schwannoma resection in the semi-sitting position, with visual demonstration of the various parts of the procedure through surgical videos. Specific recommendations for each step were outlined, including appropriate approach, monitoring strategies, and tumor and posterior fossa structures manipulation. Five major parts of the procedure were identified, leading to a reproducible standardization of the surgical procedure of vestibular schwannoma resection in the semi-sitting position. This study provides a comprehensive standardized protocol for the semi-sitting procedure in vestibular schwannoma resection. By establishing a consistent approach, surgeons can minimize variations in surgical techniques and improve patient outcomes. The identified steps and recommendations can serve as a valuable resource for surgical teams involved in vestibular schwannoma resection and facilitate the dissemination and reproducibility of best practices.

Prone Dispatch-Directed CPR in Out-of-Hospital Cardiac Arrest: Two Successful Cases

Historically, dispatch-directed cardiopulmonary resuscitation (CPR) protocols only allow chest compression instructions to be delivered for patients able to be placed in the traditional supine position. For patients who are unable to be positioned supine, the telecommunicator and caller have no option except to continue attempts to position supine, which may result in delayed or no chest compressions being delivered prior to emergency medical services arrival. Any delay or lack of bystander chest compressions may result in worsening clinical outcomes of out-of-hospital cardiac arrest (OHCA) victims. We present the first two cases, to the best of our knowledge, of successfully delivered, bystander-administered, prone CPR instructions by a trained telecommunicator for two OHCA victims unable to be positioned supine.

Effect of prone position ventilation on right heart function in patients with acute respiratory distress syndrome.

Acute respiratory distress syndrome (ARDS) is a severe respiratory disease with a high mortality rate. It is characterized by acute onset of pulmonary edema, hypoxemia, and the need of mechanical ventilation. As the primary treatment, ventilation has been considered effective in treating patients with ARDS. Recently, numerous studies have shown that prone position ventilation demonstrates more efficacy compared with traditional supine position. However, the potential impact of the non-physiological prone position on patients remains unclear. Current study aims to evaluate the effect of prone position ventilation on right heart function in ARDS patients. Following Berlin Diagnostic Criteria, 80 eligible patients were recruited and randomly assigned into prone position ventilation group and supine position ventilation group. Different ventilation methods were implemented in these two groups. Both positions showed the beneficial effects, as evidenced by decreased PV score and APACHE II score, enhanced blood gas index and right heart function parameters, and the prognosis analysis. However, compared with those receiving SPV treatment, the patients demonstrated greater benefits from PPV treatment, with significant differences in PV score (p < 0.01) and APACHE II score (p < 0.001), blood gas index such as PAPm (p < 0.05), and right heart function indicators (p < 0.05). Prone position mechanical ventilation is more beneficial than supine position ventilation in improving the blood gas status of patients with moderate to severe ARDS, and it is more helpful to reduce the load on the right heart and promote the recovery of patients.

Weight-Bearing Magnetic Resonance Imaging as a Diagnostic Tool That Generates Biomechanical Changes in Spine Anatomy.

Weight-bearing magnetic resonance imaging (MRI) is a unique modality in diagnostic imaging that allows for the assessment of spinal pathology in ways considered previously inaccessible or insufficient with the conventional MRI technique. Due to limitations in positioning within the MRI machine itself, difficulties would be posed in determining the underlying cause of a patient’s pain or neurological symptoms, as the traditional supine position utilized can, in many cases, alleviate the severity of presented symptoms. Weight-bearing MRI addresses this concern by allowing a clinician to position a patient (to a certain degree) into flexion, extension, rotation, or side-bending with an axial load that can mimic physiologic conditions in order to replicate the conditions the patient experiences in order to give clinicians a clearer understanding of the anatomical relationship of the spine and surrounding tissues that may lead to a particular presentation of symptoms. These findings can then guide treatment approaches that are better tailored to a patient’s needs in order to initiate treatment earlier and shorten the duration of treatment necessary for patient benefit. The goal of this review is to describe and differentiate weight-bearing MRI from conventional MRI as well as examine the advantages and disadvantages of either imaging modality. This will include assessing cost-effectiveness and improvements in clinical outcomes. Further, the advancements of weight-bearing MRI will be discussed, including potentially unique clinical applications in development.

Transverse abdominis activity and ultrasound biofeedback in college golfers with and without low back pain

ObjectivesTo compare transverse abdominis (TrA) muscle activity in college golfers with and without a history of low back pain (LBP) and examine the effects of ultrasound biofeedback and a functional golf-setup position on TrA activity. DesignCrossover study. SettingLaboratory. ParticipantsThirty-two (n = 32) collegiate golfers were stratified into either the LBP group (n = 16, 4.6 ± 4.5 LBP episodes) or non-LBP group (n = 16, 0.1 ± 0.3 LBP episodes) based on LBP episodes in the last 6-months. Main outcome measuresUltrasound measures of TrA activity were performed during standard contractions and contractions with ultrasound biofeedback. Contraction-type order was randomized between two visits. Testing was performed in two positions, supine and golf-setup positions. ResultsWe observed no significant differences in TrA activity between the LBP and non-LBP groups. Overall, TrA activity was greater during biofeedback contractions compared to standard contractions, and TrA activity was lower in the golf-setup position compared to the supine position. ConclusionsWe observed no differences in TrA activity between college golfers with and without LBP. College golfers with and without LBP demonstrated a greater ability to contract their TrA with real-time ultrasound biofeedback and a lower ability to contract their TrA in the functional golf-setup position compared to the traditional supine position.

Controlled sequential elevation of the head and thorax combined with active compression decompression cardiopulmonary resuscitation and an impedance threshold device improves neurological survival in a porcine model of cardiac arrest

Aim of the studyControlled sequential elevation of the head and thorax (CSE) during active compression decompression (ACD) cardiopulmonary resuscitation (CPR) with an impedance threshold device (ITD) has been shown to increase cerebral perfusion pressure and cerebral blood flow in previous animal studies as compared to the traditional supine position. The potential for this novel bundled treatment strategy to improve survival with intact neurological function is unknown. MethodsFemale farm pigs were sedated, intubated, and anesthetized. Central arterial and venous access were continuously monitored. Regional brain tissue perfusion (CerO2) was also measured transcutaneous. Ventricular fibrillation (VF) was induced and untreated for 10 min. Pigs were randomized to (1) Conventional CPR (C-CPR) flat or (2) ACD + ITD CSE CPR that included 2 min of ACD + ITD with the head and heart first elevated 10 and 8 cm, and then gradual elevation over 2 min to 22 and 9 cm, respectively. After 19 min of CPR, pigs were defibrillated and recovered. A veterinarian blinded to the intervention assessed cerebral performance category (CPC) at 24 h. A neurologically intact outcome was defined as a CPC score of 1 or 2. Categorical outcomes were analyzed by Fisher's exact test and continuous outcomes with an unpaired student's t-test. ResultsIn 16 animals, return of spontaneous circulation rate was 8/8 (100%) with ACD + ITD CSE and 3/8 (25%) for C-CPR (p = 0.026). For the primary outcome of neurologically intact survival, 6/8 (75%) pigs had a CPC score 1 or 2 with ACD + ITD CSE versus 1/8 (12.5%) with C-CPR (p = 0.04). Coronary perfusion pressure (mmHg, mean ± SD) was higher with CSE at 18 min (41 ± 24 versus 10 ± 5, p = 0.004). rSO2 (%, mean ± SD) and ETCO2 (mmHg, mean ± SD) values were higher at 18 min with CSE (32 ± 9 versus 17 ± 2, p = 0.01, and 55 mmHg ± 10 versus 21 mmHg ± 4, p < 0.001), respectively. ConclusionsThe novel bundled resuscitation approach of CSE with ACD + ITD CPR increased favorable neurological survival versus C-CPR in a swine model of cardiac arrest.

Application of lithotomy position in closed reduction and interlocking intramedullary nail fixation for tibial shaft fracture

To explore the application value of lithotomy position in the treatment of tibial shaft fracture with closed reduction and interlocking intramedullary nail fixation. The clinical data of 78 patients with tibial shaft fractures treated with closed reduction and interlocking intramedullary nail fixation between January 2015 and May 2018 were retrospectively analyzed. Among them, 33 patients were treated with lithotomy position (trial group) and 45 patients were treated with traditional supine position (control group). There was no significant difference between the two groups in general data such as gender, age, the cause of injury, the interval between injury and admission, the interval between injury and operation, and fracture type and site ( P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy times, the number of patients with open reduction, postoperative incision infection, and fracture healing were recorded. Pain visual analogue scale (VAS) score and Harris score were used to evaluate the effectiveness. Both groups of operations were successfully completed. The trial group was superior to the control group in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy times, and the number of patients with open reduction ( P<0.05). Incision infection occurred in 1 case (3.03%) of the trial group and 3 cases (6.67%) of the control group after operation. The difference in the incidence of infection was significant ( χ 2=0.139, P=0.045). The incisions of other patients healed by first intention. X-ray film reexamination showed that the fractures of the two groups healed. The fracture healing time of the trial group was (5.30±1.33) months, while that of the control group was (5.98±1.80) months, with no significant difference ( t=-1.815, P=0.073). There was no significant difference in VAS score, Harris scores of knee joint and ankle joint between the two groups before operation and at 3, 6, and 12 months after operation ( P>0.05). At 3 days after operation, the VAS score was lower in the trial group than in the control group, and the Harris scores of knee joint and ankle joint were higher in the trial group than in the control group, and the differences were significant ( P<0.05). Application of lithotomy position in closed reduction and interlocking intramedullary nail fixation for tibial shaft fracture is favorable for fracture reduction, with less bleeding, shorter operation time, and fewer fluoroscopy.

A critical literature review on the use of bellyboard devices to control small bowel dose for pelvic radiotherapy.

Delivering curative radiotherapy doses for rectal and gynaecological tumours has historically been complicated by the dose tolerance of the small bowel. Acute radiation-induced small bowel toxicity includes side effects such as abdominal pain, nausea and diarrhoea. With the advent of new treatment delivery modalities, such as IMRT (Intensity modulated radiotherapy) and VMAT (Volumetric modulated Arc radiotherapy), there has been an expectation that small bowel doses can be better controlled with the use of these technologies. These capabilities enable the creation of treatment plans that can better avoid critical radiosensitive organs. The purpose of this review is to look beyond advances in linear accelerator technology in seeking improvements to small bowel dose and toxicity. This review examines whether an alternative prone patient positioning approach using a bellyboard device in conjunction with IMRT and VMAT treatment delivery can reduce small bowel doses further than using these technologies with the patient in a traditional supine position.

Use of a head-tilting baseplate during volumetric-modulated arc therapy (VMAT) to better protect organs at risk in hippocampal sparing whole brain radiotherapy (HS-WBRT).

Coplanar arcs are used with limited arc range to prevent direct beam entrance through the lens, which is challenging for satisfactory planning of hippocampal sparing in whole brain radiotherapy (HS-WBRT) with VMAT. We evaluated the dosimetric impact of applying a head-tilting technique during VMAT, which allows unrestricted use of the arc range. Twenty patients with multiple brain metastases who had received two computed tomography (CT)-simulation sessions between January 2016 and December 2018 were included. One session was delivered in a traditional supine position; the other was delivered with a tilting acrylic supine baseplate (MedTec, USA) to elevate the patients' head by 40°. For each patient, a VMAT without (sVMAT) and with head-tilting (htVMAT) plan was generated. Conformity index (CI), homogeneity index (HI), and organ at risk (OAR) dose were evaluated. The Wilcoxon-signed test was used to compare the effect between two plans. The mean CI was 0.860±0.007 and 0.864±0.008 (p<0.05), and mean HI was 0.179±0.020 and 0.167±0.021 (p<0.05) for sVMAT and htVMAT, respectively. The mean dose to the hippocampus (9.91±0.30 Gy) was significantly lower in htVMAT than in sVMAT (10.36±0.29 Gy, P<0.05). htVMAT was associated with significantly reduced mean dose to the parotid gland, and right and left lens (4.77±1.97 Gy vs. 5.92±1.68 Gy, p<0.05; 3.29±0.44 Gy vs. 7.22±1.26 Gy, p<0.05; 3.33±0.45 Gy vs. 6.73±1.01 Gy, p<0.05, respectively). This is the first study to demonstrate that the head-tilting technique might be useful for HS-WBRT planning with VMAT. This method could remove the limitations associated with the arc range, resulting in improved dose distribution and conformity, while sparing healthy organs, including the hippocampus, lens, and parotid gland.

Whole brain radiotherapy using four-field box technique with tilting baseplate for parotid gland sparing.

PurposeThe aim of this study is to evaluate the efficacy and feasibility of four-field box whole brain radiotherapy (FB-WBRT) with tilting baseplate by comparing bilateral WBRT (B-WBRT).Methods and MaterialsBetween March 2016 and September 2018, 20 patients with brain metastases underwent WBRT using the four-field box technique. WBRT is performed with a dose of 30 Gy in 10 fractions daily. Two computed tomography simulations per person were performed. One was in the traditional supine position for B-WBRT and the other by applying the tilting acrylic supine baseplate to elevate the head by 40° for FB-WBRT. The B-WBRT used the field-in-field technique, which is the most commonly used method in our institution. The FB-WBRT comprised anterior, posterior, and bilateral beams. A wedge was applied in anterior and posterior fields to compensate for skull convexity.ResultsThe average of Dmean of both parotid glands was 10.2 Gy (range, 3.8 to 17.8 Gy) in B-WBRT and 5.4 Gy (range, 2.0 to 11.7 Gy) in FB-WBRT (p < 0.05). Compared to B-WBRT, FB-WBRT reduced the mean dose of the right and left parotid glands from 10.1 Gy to 4.9 Gy and from 10.4 Gy to 5.8 Gy, respectively (p < 0.05). Further, V5, V10, V15, V20, and V25 for the parotid gland decreased significantly in FB-WBRT (p < 0.05). The Dmax and Dmean of lens decreased according to the dose-volume histogram.ConclusionCompared to B-WBRT, FB-WBRT with a tilting baseplate is a simple and effective method that takes feature of noncoplanar beam to protect the parotid gland.

Axillary sentinel node biopsy in prone position for melanomas on the upper back or nape

In patients with melanomas on the upper back or nape, axillary sentinel lymph node (SLN) biopsy (SLNB), when performed in the traditional supine position, is often disturbed by scattered radiation emitted from the primary tumor site. The results from the present study suggestthat axillary SLNB performed in the prone position can solve this problem. We compared two consecutive groups of patients with melanomas of the dorsal trunk or nape who received axillary SLNB performed either in the supine (n = 119) or in the prone position (n = 130). The number of SLNs detected and excised was significantly higher in prone position group (2.4 ± 1.5 SLNs versus 1.9 ± 0.95 SLNs, p = 0.002). Using the prone position, intra-operative repositioning of the patient for excision of a primary site of the upper back or neck was not necessary. The SLN identification rates and the SLN-positivity rates did not differ significantly between the two types of intraoperative patient positioning. There were no significant differences in survival outcomes or false-negative rates. In conclusion, axillary SLNB in prone position yields a higher number of excised SLNs in patients with melanomas of the upper back or nape. Axillary SLNB in prone position is easy to perform and reliable. Intraoperative repositioning of the patient is not necessary, which saves time and resources.

Bladder scan accuracy in pediatric patients: Does patient position matter?

Despite its widespread use in pediatric urology clinics, portable bladder scanning is an insufficiently studied tool that lacks standardized protocols. Workflow at the present clinic can be impeded by scanning in the supine position, due to multiple trips to the restroom and back to the exam room. The current study sought to test accuracy of bladder scanning, and hypothesized that it would be equally accurate in the standing versus traditional supine position in children, given the intra-abdominal location of their bladders. Sixty children from the bladder/bowel clinic were prospectively recruited. Patients had a formal supine renal/bladder ultrasound and pre-void and/or post-void assessment with scans in both the standing and supine positions. The methods were compared using repeated measures one-way ANOVA. Mean age was 9.2 years. The majority (85%) were female. All bladder scan estimates except for post-void supine significantly correlated with ultrasound volume. Pre-void standing had the strongest correlation (r=0.83). There was no difference between ultrasound and standing estimates for pre-void volumes, but supine underestimated volumes by 44.8ml(P<0.01) (Summary Figure). Sub-group analysis of children aged <10 years showed that pre-void scans in both positions significantly underestimated volume (12% of estimated bladder capacity for standing, 24% for supine, P<0.05). For post-void volumes, both standing and supine overestimated measurements by 29.4ml and 18.3ml, respectively (both P<0.001). Sub-group analysis based on age yielded comparable results. It is believed that this is the first study to examine bladder scanning in different positions. Limitations included small sample size, and the study fell short of cost-effectiveness and outcome analysis to assess the real-life impact of the proposed use of standing bladder scanning in the clinic. Standing bladder scanning may be used in place of supine. However, bladder scanning generally appeared to have poor accuracy, especially in younger children, and thus should be used with caution. In practical terms, it may decrease specificity of detecting elevated post-void residuals compared to ultrasound.

Virtual reality as a countermeasure for physical training in bed rest and artificial gravity conditions.

Virtual reality as a countermeasure for physical training in bed rest and artificial gravity conditions.

A Prospective Randomized Trial of Postural Changes vs Passive Supine Lying during the Second Stage of Labor under Epidural Analgesia.

There exist very few studies comparing different postures or postural changes during labor in parturients with epidural analgesia. Aim: To disclose whether the intervention of a multidisciplinary nursing team including a physiotherapist during the second stage of labor improves the obstetric outcome in parturients with epidural analgesia. Design: Prospective randomized trial. Setting: University-affiliated hospital. Population: Women undergoing labor with epidural analgesia after a normal gestation. Methods: 150 women were randomized either to actively perform predefined postural changes during the passive phase of the second stage of labor under the guidance of the attending physiotherapist (study group), or to carry out the whole second stage of labor lying in the traditional supine position (control group). Results: There were significantly more eutocic deliveries (p = 0.005) and, conversely, significantly less instrumental deliveries (p < 0.05) and cesarean sections (p < 0.05) in the study group. The total duration of the second stage of labor was significantly shorter (p < 0.01) in the study group. This was at the expense of the passive phase of the second stage of labor (p < 0.01). Significantly less episiotomies were performed in the study group (31.2% vs 17.8%, p < 0.05). Conclusion: The intervention of a physiotherapist during the second stage of labor significantly improved the obstetric outcome.

Effects of different surgical position on the comfort of surgeons and patients during hepatectomy

Objective To investigate the effects of different surgical position on the comfort of surgeons and patients during hepatectomy. Methods One hundred patients with liver carcinoma in Southern Hospital of Southern Medical University from October 2014 to October 2015 were selected by purposive sampling method. Patients were simply randomly divided into the observation group and the control group by computer generated random numbers, with 50 patients in each group. Patients in two groups were operated by the same team of surgeons using the same basic surgical approach. The control group adopted the traditional supine position, while the observation group used the modified position placement method. Patient′s comfort, the convenience and comfort of surgeons as well as postoperative position related complications were evaluated. Results In the observation group, after the application of modified supine position placement, patients′ comfort was significantly higher compared to the control group (Z=-3.458, -9.210; P<0.01) . The convenience of surgeons significantly increased, and the operation comfort was significantly higher compared to the control group (χ2=7.440, 6.061; P<0.01) . The satisfaction of patients and surgeons significantly increased. In the observation group, patients′ satisfaction was 94.0% and the surgeons′ satisfaction was 96.0%, and they were significantly higher compared to the control group (patients: 74.0%, surgeons: 80.0%; P<0.01) . Conclusions During hepatectomy, the application of modified operation position has a good effect on reducing intraoperative physical fatigue and improving the postoperative comfort of patients. Key words: Liver carcinoma; Operation position; Comfort; Satisfaction

Reproducibility of patient setup in the seated treatment position: A novel treatment chair design.

Radiotherapy in a seated position may be indicated for patients who are unable to lie on the treatment couch for the duration of treatment, in scenarios where a seated treatment position provides superior anatomical positioning and dose distributions, or for a low‐cost system designed using a fixed treatment beam and rotating seated patient. In this study, we report a novel treatment chair that was constructed to allow for three‐dimensional imaging and treatment delivery while ensuring robust immobilization, providing reproducibility equivalent to that in the traditional supine position. Five patients undergoing radiation treatment for head‐and‐neck cancers were enrolled and were setup in the chair, with immobilization devices created, and then imaged with orthogonal X‐rays in a scenario that mimicked radiation treatments (without treatment delivery). Six subregions of the acquired images were rigidly registered to evaluate intra‐ and interfraction displacement and chair construction. Displacements under conditions of simulated image guidance were acquired by first registering one subregion; the residual displacement of other subregions was then measured. Additionally, we administered a patient questionnaire to gain patient feedback and assess comparison to the supine position. Average inter‐ and intrafraction displacements of all subregions in the seated position were less than 2 and 3 mm, respectively. When image guidance was simulated, L‐R and A‐P interfraction displacements were reduced by an average of 1 mm, providing setup of comparable quality to supine setups. The enrolled patients, who had no indication for a seated treatment position, reported no preference in the seated or the supine position. The novel chair design provides acceptable inter‐ and intrafraction displacement, with reproducibility equivalent to that reported for patients in the supine position. Patient feedback will be incorporated in the refinement of the chair, facilitating treatment of head‐and‐neck cancer in patients who are unable to lie for the duration of treatment or for use in an economical fixed‐beam setup.

Transoral robotic surgery in the seated position: Rethinking our operative approach.

Transoral surgery (TOS) is commonly performed in a supine patient with an oral retractor. Paradoxically, this strategy can create difficulty with visualizing and accessing pathology at the base of tongue, inferior pharynx, and larynx. We investigate the feasibility of TOS with the patient in the seated position. Pilot study. TOS utilizing the da Vinci Robotic Surgical Xi and Si systems (Intuitive Surgical, Sunnyvale, CA) was performed on a fresh cadaver placed in both the traditional supine position and the seated position. Transoral robotic surgery (TORS) in the seated position was then performed on two patients for a supraglottic laryngectomy and a hypopharyngeal carcinoma resection. Visualization of the entire upper aerodigestive tract was possible in the cadaver and two patients in the seated position. The Si was superior for docking, instrumentation, and assistant access. The minimum operating table height is critical for successful access. Advantages of this position included increased posterior airway/operative space by approximately 2 cm, ability to manipulate the surgical field (nonrigid retraction), and improved visualization. Surgical procedures were completed in comparable times compared with standard TORS procedures. There were no complications related to seated TORS. TORS in the seated position was both safe and effective in this pilot study. It allows the surgeon to optimally operate in the inferior pharynx and larynx without the limitation of line of site access and visualization. A paradigm shift in patient positioning during TOS may allow improved surgical access and even greater patient candidacy. Further clinical investigation into this technique is warranted. NA Laryngoscope, 127:122-126, 2017.

Effect of Change of Mechanical Ventilation Position on the Treatment of Neonatal Respiratory Failure.

The aim of the study was to evaluate the effect of different ventilation positions in newborn infants with respiratory failure. A total of 67 newborn infant cases with respiratory failure were treated in neonatal intensive care unit of Xuzhou Central Hospital from February 2012 to August 2013. These infants were randomly divided into supine group (n=33) and different position group (n=34). Supine position for 4h and prone position for 4h were alternated in different position group. The results for 8 and 16h ventilator parameters: oxygenation index OI (OI=PaO2/FiO2), the lung mechanics parameters, ventilator weaning time, arterial carbon dioxide partial pressure (PaCO2), and arterial oxygen tension (PaO2) after 1h of ventilator weaning were recorded and compared. PaO2 in the different position ventilation groups for 8h (65.29±7.62mm Hg) and 16h (67.52±9.31mm Hg) were correspondingly higher than PaO2 at 8h (60.13±8.95mm Hg) and 16h (62.22±10.83mm Hg) in the supine position ventilation group, and the difference was statistically significant (P<0.05), whereas OI at 8h (166.95±25.27mm Hg) and 16h (169.59±20.28mm Hg) in the former group was correspondingly higher than the OI at 8h (150.16±20.51mm Hg) and 16h (152.23±22.45mm Hg) in the latter group, and the difference was statistically significant (P<0.05). The ventilator weaning time of the two groups and the change in the PaCO2 and PaO2, an hour after ventilator weaning was very similar and the difference was not statistically significant (P>0.05). The symptoms of respiratory failure and oxygenation can be effectively improved in the newborn infants with different ventilation positions compared to traditional supine position.