Table 1: The above table represents the relation between the with pillow and without pillow of the MAP and heart rate. Almost all the studied group had a preoperative bowel preparation and were categorized ASA 1-2 (96% and 100%) (Figure 3).įigure 3: This chart represents the relation between the with pillow and without pillow of the ASA. In both the studied groups, 52% and 60% of the patients did not have previous pelvic surgeries. In the other group, without the pillow, most of the surgeries (32%) were for Pelvic Pain/Endometriosis, 24% had TLH and 24% had myomectomies (Figure 2).įigure 2: This bar chart describes the percentage of the indications of laparoscopic procedures involved, using the pillow and without it.
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While 28% of the cases were operated for pelvic pain and endometriosis. Among the group with pillow, most of the surgical indications (36%) were for Infertility, Ovarian Cystectomy, Salpingectomies and Ligamentopexy surgeries. RESULTSĪmong both the studied groups “with and without the pillow”, most of the population (68%) and (56%), were between 20-40 years of age and most of them (44%) & (52%) had a BMI between 25-29.9.
Trendelenburg position software#
The SPSS Statistics software package was used and statistics significance using the P value tests. On the operating table, the bottoms of the patients were elevated using the pillow (Figure 1).įigure 1: Patient positioning and technique of the pillow placement Reduce the trendelenburg degree until the bowel loops start to return down.Place the patient on high- extreme trendelenburg position.The technique steps which we performed for all the patients were: The study was conducted during a period of 9months from Dec 2015 till September 2016. Other parameters like the patient’s Age, BMI, type of surgery, previous surgeries, respiratory and cardiovascular parameters, surgery difficulties and duration, postoperative shoulder and back pain, face oedema were also studied. The operators were limited to 2 surgeons. The degree of trendelenburg was noted during the procedure. On the operating table, the bottoms of the patients were elevated using one rectangular pillow for all of them, which was around 40cm long x 25cm wide and 25cm thick. There was no significant difference for both groups in terms of surgical difficulties, postoperative orientation, face oedema (chi-square=3.030, p=0.189), back pain (chi-square=1.087, p=0.609), shoulder pain (chi-square=0.758, p=0.667) and hospital stay.Ģ5 patients were experimented with the new technique, against a control group of 25. The cardiovascular and respiratory parameters were in the normal range for most of both the studied groups. Most of the included population were between 20-40 years of age, had a BMI between 25-29.9, and were mostly operated for Infertility, pelvic pain and endometriosis. A covered envelope with 25 cards named ’with pillow’ and 25 cards ‘without pillow’ were given to an uninvolved person to pick a card everyday and accordingly we involve it. METHODOLOGYĥ0 patient’s undergone Gynaecological laparoscopic surgeries in Latifa Hospital were studied. This reduction of the angle degree of trendelenburg shall therefore reduce the adverse effects of prolonged decreased venous return from the head, as well as the cardiovascular and respiratory effects.
Trendelenburg position free#
Our study aims to demonstrate a technique to reduce the angle degree of trendelenburg positioning of the patients undergoing gynaecological laparoscopic surgeries at a degree where the pelvis is free from the bowel. Hence, the purpose of this study is to validate the efficacy of this technique. However, this technique is not currently routinely or widely used and there is no much published data about its outcomes.
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Moreover, as a result of venous stagnation, cyanosis and oedema in the face and neck may be expected.ĭifferent Authors proposed to place an elevation under the patient’s buttocks to reduce the angle of trendelenburg, providing good pelvis exposure. If this position is maintained for an extended duration, cerebral oedema and retinal detachment may occur. If the patient is placed in extreme trendelenburg, a decrease in venous return from the head may result, leading to increased intracranial and intraocular pressures. It also increases the venous return and Cardiac Output. This position in awake and anaesthetised patients increases the pulmonary arterial pressures, Central Venous Pressure (CVP) and Pulmonary Capillary Wedge Pressure (PCWP). In this position the patient is kept supine and the head is tilted down to a degree of 15-20 on average. The trendelenburg position is quite essential during laparoscopic surgeries because it facilitates emptying the pelvis from the bowel, hence the surgeon can perform the surgery more efficiently and safely.