INTRODUCTION: Flank positioning with the patient's ipsilateral arm elevated over the head on an arm board is often used during laparoscopic kidney surgery. There have been reports of brachial plexus neuropraxia, rhabdomyolysis and other complications related to this positioning. Herein we describe our modified positioning technique for laparoscopic renal surgery.
METHOD: Beginning in November 2003, all patients undergoing laparoscopic renal surgery have been positioned in the 30 degree modified flank position. The ipsilateral arm on the surgical side is not elevated on an arm board but lies in an ergonomic 'sling' position with the elbow flexed slightly greater than 90 degrees. The chest, hips, and knees are secured with tape to allow for extreme table rotation which creates a 'true' flank angle relative to the horizontal.
RESULTS: Over 1240 cases have been performed utilizing this method, with no events of rhabdomyolysis or neuropraxia secondary to positioning. All patients up to a body mass index (BMI) of 67 kg/m2 have successfully undergone laparoscopic renal surgery with this method without any limitation encountered secondary to positioning.
CONCLUSIONS: This novel technique allows for more ergonomic arm positioning as well as significantly decreased pressure on the contralateral down side. The use of extreme table rotation eliminates the need for conventional flank positioning which employs table flexion, arm boards, and axillary rolls. This technique allows for rapid, easy, and safe positioning with no related complications in 1240 laparoscopic kidney cases.