Surgical Products connected with Dan Allen, founder of D.A. Surgical, to discuss holes in education on proper patient positioning for robotic procedures.

 “My number one concern remains that clinicians have not yet embraced zero tolerance for patients sliding during robotic surgery,” Allen emphasized. “The literature makes clear that the risks associated with patients sliding during robotic are just too great to ignore yet many robotic programs continue to use devices that put patients at risk.”

How have you seen surgical teams compensate for a lack of specialized robotic surgery positioning devices?

Allen: I have witnessed the use of a number of techniques that utilize miscellaneous materials that were never intended to be used for Trendelenburg restraint.  It happens every day in small community hospitals and in giant university medical centers across the country.  I have seen patients with straps across their chest wrapped in tape and egg-crate foam.  I have witnessed patients sliding while on gel pad overlays.  I have read about shoulder braces being used in combination with bean bag restraints because when bean bags loose vacuum they no longer support the patient.

What affects does this have on the patient or procedure?

Allen:  It is a simple fact that when patients slide during GYN surgery that the uterine manipulator becomes less effective due to the loss or range of motion.  Occasionally the surgeon must stop surgery, undock and reposition the patient.

It is also a simple fact that when patients slide during robotic assisted surgery that the task of restraining the patient transitions from the restraint device to the ‘meat hook restraint technique.’ The trocars, instruments and arms of the robot eventually act to hold the patient on the table.  The results of this ‘meat hook’ style patient restraint include incisional tear, post-operative hernia formation, necrosis at the camera port and Increased postoperative pain secondary to overstretching of the anterior abdominal wall. In other words when patients slide they can suffer serious and unnecessary injury.

How can the approach to robotic surgery positioning be improved?

Allen:  In the early days of robotic surgery surgeons and nurses did the best they could with the miscellaneous materials they could get their hands on.  There was no quality control, no risk assessment and while not every patient slid it is well known that patients continued to slide from time to time. 

The medical device industry has answered the call.  Trendelenburg restraint technology exists that was purpose built to effectively and safely keep patients static on the OR table even in the most extreme Trendelenburg inclinations.  That technology has never had a single report of patient sliding, a report of post-operative discomfort or a report of patient injury. 

What steps can be taken to assure that patients are not sliding?

Allen:  The only way clinicians will know whether or not their Trendelenburg restraint is effective is to practice Mark, Check and Chart™ with at least 50 patients. 

• MARK the patient’s position on the table (using a common landmark like an ear or put a mark on the hip and a corresponding mark on the table) prior to transitioning into Trendelenburg.
• CHECK the Mark at the end of the procedure to see if the patient has moved.
• CHART any change in patient location on the table.

If after practicing Mark, Check and Chart™ on a minimum of 50 patients you find that patients are not sliding then you are using the right technology.  If you find that patients are moving – even just a little bit – do the research and invest in proven Trendelenburg restraint technology.

Mark, Check and Chart is a trademark of D.A. Surgical.