Journal of Robotic Surgery

, Volume 12, Issue 1, pp 97–101 | Cite as

Prospective assessment of positioning-related pain in robotic urologic surgery

  • Kevin B. Ginsburg
  • Kelsey Pape
  • Chase Heilbronn
  • Michael Levin
  • Michael L. Cher
Original Article


This was a prospective study to assess positioning-related pain in 20 awake volunteers in the dorsal lithotomy (DL) and lateral decubitus (LD) positions. Each volunteer was put through the series of discrete, sequential steps used to achieve a final position; each step had two options. The Wong-Baker scale (WB) was used to rate pain for each option and the preferred option and ad lib comments were recorded. We found that awake volunteers could clearly and immediately distinguish differences in pain levels between position options. For the DL position, volunteers favored having the arms slightly flexed and pronated as opposed to being straight and supinated reflected by statistically less painful WB scores and option preference. Volunteers preferred having the neck flexed as opposed to being flat. For the LD position, volunteers reported statistically lower pain scores and preference for a foam roll for axilla support as opposed to a rolled blanket, the table flexed without the kidney rest as opposed to a raised kidney rest, and the over arm board as oppose to stacked blankets for contralateral arm support. Ad lib comments from the volunteers supported the above findings. To our knowledge, ours is the first study to demonstrate objective preferences for variations in surgical positioning using awake volunteers. This exercise with awake volunteers resulted in immediate changes in positioning for real robotic surgery patients in our practice.


Patient positioning Patient safety Neuromuscular injuries Robotic surgery Dorsal lithotomy Lateral decubitus 



Axilla support


Contralateral arm support


Flank support


Head support


Kidney rest


Neck position


Securing arms


Securing the body


Supporting the legs


Wong-Baker scale



KBG, KP, and CH performed the research, ML and MLC designed the research study, KBG analyzed the data, KBG and MLC wrote the manuscript. All authors have revised the manuscript critically and approve of the final version.

Compliance with ethical standards

Source of funding


Conflict of interest

All authors, KBG, KP, CH, ML, and MLC declare that they have no conflicts of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

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Supplementary material 1 (DOCX 60 kb)
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Supplementary material 2 (DOCX 44 kb)
11701_2017_701_MOESM3_ESM.docx (31 kb)
Supplementary material 3 (DOCX 30 kb)


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Copyright information

© Springer-Verlag London 2017

Authors and Affiliations

  • Kevin B. Ginsburg
    • 1
  • Kelsey Pape
    • 2
  • Chase Heilbronn
    • 2
  • Michael Levin
    • 1
  • Michael L. Cher
    • 1
  1. 1.Department of Urology, University Health CenterWayne State University School of MedicineDetroitUSA
  2. 2.Wayne State University School of MedicineDetroitUSA

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