WordNet

cause to be in an appropriate place, state, or relation
a job in an organization; "he occupied a post in the treasury" (同)post, berth, office, spot, billet, place, situation
the arrangement of the body and its limbs; "he assumed an attitude of surrender" (同)posture, attitude
the spatial property of a place where or way in which something is situated; "the position of the hands on the clock"; "he specified the spatial relations of every piece of furniture on the stage" (同)spatial relation
(in team sports) the role assigned to an individual player; "what position does he play?"
the act of positing; an assumption taken as a postulate or axiom
the particular portion of space occupied by something; "he put the lamp back in its place" (同)place
a rationalized mental attitude (同)stance, posture
a way of regarding situations or topics etc.; "consider what follows from the positivist view" (同)view, perspective
the appropriate or customary location; "the cars were in position"
surgical removal of a stone (calculus)

PrepTutorEJDIC

〈C〉『位置;場所』;所在地 / 〈U〉所定の位置,適所 / 〈C〉『姿勢』,構え / 〈U〉有利な地位(立場) / 〈C〉《通例単数形で》(周囲の状況と関連する)『立場,境遇』;形勢,情況 / 〈C〉見解,態度 / 〈C〉(…としての)勤め口,職《+『as(of)+名』》 / 〈C〉(…の中の)地位《+『in+名』》 / 〈U〉(特に高い)社会的地位 / 《副詞[句]を伴って》…‘を'適当な(特定の)場所に置く

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/07/24 15:31:51」(JST)

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Lithotomy position.

The lithotomy position is a medical term referring to a common position for surgical procedures and medical examinations involving the pelvis and lower abdomen, as well as a common position for childbirth in Western nations. The lithotomy position involves the positioning of an individual's feet above or at the same level as the hips (often in stirrups), with the perineum positioned at the edge of an examination table. References to the position have been found in some of the oldest known medical documents including versions of the Hippocratic oath (see lithotomy); the position is named after the ancient surgical procedure for removing kidney stones, gall stones and bladder stones via the perineum. The position is perhaps most recognizable as the 'often used' position for childbirth: the patient is laid on the back with knees bent, positioned above the hips, and spread apart through the use of stirrups.

The position is frequently used and has many obvious benefits from the doctor's perspective. Most notably the position provides good visual and physical access to the perineal region. The position is used for procedures ranging from simple pelvic exams to surgeries and procedures including those involving reproductive organs, urology, and gastrointestinal systems. New observations and scientific findings, combined with a greater sensitivity to patient needs have raised awareness of the physical and psychological risks the position may pose for prolonged surgical procedures, pelvic examinations, and, most notably, childbirth.

Use for prolonged surgical procedures

Some studies have found a significant relationship between prolonged surgical procedures with the patient in the lithotomy position and a circulatory complication known as compartment syndrome,^[1]^[2] Nerve injury by pressure is also possible, the femoral or peroneal nerve are at risk.^[3]

Use for childbirth

A Cochrane Review found that the lithotomy position may not be the ideal position for child birth, noting that while it makes care easier for physicians by placing the patient in an easily accessible position, it is often harder on birthing mothers as use of the lithotomy position can narrow the birth canal by up to a third. In lieu of the lithotomy position, the Cochrane Review recommended birthing mothers make informed choices about birthing positions and find the position that is most comfortable for them.^[4]

Use for pelvic examinations

Patients have reported feeling a loss of control and increased sense of vulnerability when examined in the lithotomy position because they cannot see the area being examined. Other, equally effective positions have been suggested for examinations of conscious patients.^[5]^[6]

References

^ Anema JG, Morey AF, McAninch JW, Mario LA, Wessells H (August 2000). "Complications related to the high lithotomy position during urethral reconstruction". Journal of Urology 164 (2): 360–3. doi:10.1016/S0022-5347(05)67360-0. PMID 10893585.
^ Cohen SA, Hurt WG (May 2001). "Compartment syndrome associated with lithotomy position and intermittent compression stockings". Obstet Gynecol 97 (5 Pt 2): 832–3. doi:10.1016/S0029-7844(00)01141-8. PMID 11336771.
^ Manski, D: Online textbook of urology http://www.urology-textbook.com/lithotomy-position.html
^ http://apps.who.int/rhl/reviews/langs/CD002006.pdf
^ "Editorials - July 1, 2000 - American Family Physician".
^ Seehusen DA, Johnson DR, Earwood JS, et al. (July 2006). "Improving women's experience during speculum examinations at routine gynaecological visits: randomised clinical trial". BMJ 333 (7560): 171. doi:10.1136/bmj.38888.588519.55. PMC 1513491. PMID 16803941.

External links

Lithotomy Position. Information and research on the use of the Lithotomy Position in Childbirth
Effect Of Lithotomy Position On Spinal Anesthesia

UpToDate Contents

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1. 泌尿婦人科における周術期患者ケアの問題 perioperative patient care issues in urogynecology
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English Journal

Well-leg compartment syndrome after gynecological laparoscopic surgery.

Boesgaard-Kjer DH, Boesgaard-Kjer D, Kjer JJ.SourceClinic of Gynecology, Rigshospitalet University Hospital, Copenhagen, Denmark.
Acta obstetricia et gynecologica Scandinavica.Acta Obstet Gynecol Scand.2013 May;92(5):598-600. doi: 10.1111/aogs.12102. Epub 2013 Mar 12.
Well-leg compartment syndrome in the lower extremities after surgery in the lithotomy position is a rare but severe complication requiring early diagnosis and intervention. Several circumstances predispose to this condition as a consequence of increased intra-compartmental pressure, such as position
PMID 23488737

Compartment syndrome following robotic-assisted prostatectomy: rhabdomyolysis in bone scintigraphy.

Yang RH, Chu YK, Huang CW.SourceFrom the Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.
Clinical nuclear medicine.Clin Nucl Med.2013 May;38(5):365-6. doi: 10.1097/RLU.0b013e318286808e.
Major urologic surgery performed in the lithotomy position sometimes results in the serious complication of rhabdomyolysis. A 56-year-old man was admitted to the hospital for prostate adenocarcinoma. A whole-body bone scan was performed to exclude bony metastases, which demonstrated no bone lesions
PMID 23429389

Robot-assisted Transrectal Hybrid Natural Orifice Translumenal Endoscopic Surgery Nephrectomy and Adrenalectomy: Initial Investigation in a Cadaver Model.

Eyraud R, Laydner H, Autorino R, Hillyer S, Long JA, Panumatrassamee K, Khalifeh A, Stein RJ, Haber GP, Kaouk JH.SourceSection of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
Urology.Urology.2013 May;81(5):1090-4. doi: 10.1016/j.urology.2012.11.006. Epub 2013 Mar 13.
OBJECTIVE: To assess the feasibility of robotic transrectal hybrid natural orifice translumenal endoscopic surgery (NOTES) nephrectomy and adrenalectomy.MATERIALS AND METHODS: A male cadaver was used for the present investigation and placed in lithotomy position. An 8- and 12-mm port was inserted th
PMID 23490523

Japanese Journal

症例全腹腔鏡下子宮全摘術(TLH)後に下肢コンパートメント症候群を生じた1例

牛島倫世,山川義寛,山﨑悠紀 [他]
産科と婦人科 81(1), 116-119, 2014-01
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腹腔鏡下内肛門括約筋切除術後に下肢のAcute compartment syndromeをきたした進行下部直腸癌の1例

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日本大腸肛門病学会雑誌 67(2), 97-102, 2014
手術に関連するAcute compartment syndrome（ACS）は稀であり，早期の診断と加療が重要である．腹腔鏡下内肛門括約筋切除術後に下肢のACSをきたした症例を経験したので報告する．症例は進行下部直腸癌の40歳代男性．術前検査で側方リンパ節転移が疑われ，術前化学療法後に腹腔鏡下内肛門括約筋切除術および治療的両側側方リンパ節郭清術を施行した．体位は開脚頭低位を基本とし，会陰操作と側方 …
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