Skip to main content
Log in

Secure patient positioning using Badillo/Trendelenburg restraint strap during robotic surgery

  • Original Article
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

Steep Trendelenburg position is routine during robotic urologic and gynecologic surgery in order to optimize exposure of the pelvis. This position requires that the patient be properly secured as to avoid any movement during the procedure. We analyzed the safety and tolerability of a reusable strap with disposable cushions used during robotic assisted radical prostatectomy. The Badillo/Trendelenburg restraint is a harness which is placed on the table prior to patient transfer. The restraint is a Class I FDA-registered device (Pintler Medical, Seattle, WA). Patients were marked at the beginning and end of the case to determine if any movement had occurred. The Badillo/Trendelenburg restraint was employed in 1,200 consecutive RARP cases. The restraint was used by a single surgeon at two institutions. The operating table was marked from edge of the patients shoulder to the end of the head of table at the beginning and end of the case to determine if any movement had occurred. Maximum movement observed was 1 cm. All patients were questioned and a physical examination were done in the post operative period for any shoulder or nerve injury. No reports of shoulder or brachial injury. For patients undergoing robotic surgery with steep Trendelenburg position the Badillo/Trendelenburg restraint provides a secure, reliable and safe means of maintaining proper position without any patient movement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Akhavan A, Gainsburg DM, Stock JA (2010) Complications associated with patient positioning in urologic surgery. Urology 76(6):1309–1316

    Article  PubMed  Google Scholar 

  2. Agostini J, Goasguen N, Mosnier H (2010) Patient positioning in laparoscopic surgery: tricks and tips. J Visc Surg 147(4):e227–e232

    Article  CAS  PubMed  Google Scholar 

  3. Winfree CJ, Kline DG (2005) Intraoperative positioning nerve injuries. Surg Neurol 63(1):5–18 (discussion 18)

    Article  PubMed  Google Scholar 

  4. Wolf JS Jr, Marcovich R, Gill IS et al (2000) Survey of neuromuscular injuries to the patient and surgeon during urologic laparoscopic surgery. Urology 55(6):831–836

    Article  PubMed  Google Scholar 

  5. Shveiky D, Aseff JN, Iglesia CB (2010) Brachial plexus injury after laparoscopic and robotic surgery. J Minim Invasive Gynecol 17(4):414–420

    Article  PubMed  Google Scholar 

  6. Barnett JC, Hurd WW, Rogers RM Jr, Williams NL, Shapiro SA (2007) Laparoscopic positioning and nerve injuries. J Minim Invasive Gynecol 14(5):664–672 (quiz 673)

    Article  PubMed  Google Scholar 

  7. Hewer CL (1953) Maintenance of the Trendelenburg position by skin friction. Lancet 1(6759):522–524

    Article  CAS  PubMed  Google Scholar 

  8. Warner MA (1998) Perioperative neuropathies. Mayo Clin Proc 73(6):567–574

    Article  CAS  PubMed  Google Scholar 

  9. Romanowski L, Reich H, McGlynn F, Adelson MD, Taylor PJ (1993) Brachial plexus neuropathies after advanced laparoscopic surgery. Fertil Steril 60(4):729–732

    CAS  PubMed  Google Scholar 

  10. Kent CD, Cheney FW (2007) A case of bilateral brachial plexus palsy due to shoulder braces. J Clin Anesth 19(6):482–484

    Article  PubMed  Google Scholar 

  11. Klauschie J, Wechter ME, Jacob K et al (2010) Use of anti-skid material and patient-positioning to prevent patient shifting during robotic-assisted gynecologic procedures. J Minim Invasive Gynecol 17(4):504–507

    Article  PubMed  Google Scholar 

  12. Navarro-Vicente F, Garcia-Granero A, Frasson M et al (2012) Prospective evaluation of intraoperative peripheral nerve injury in colorectal surgery. Colorectal Dis 14(3):382–385

    Article  CAS  PubMed  Google Scholar 

  13. Challa SR, Majumdar A, Harrison G, Smith K (2008) Use of a mouldable beanbag to aid positioning of patients. Br J Oral Maxillofac Surg 46(7):611–612

    Article  CAS  PubMed  Google Scholar 

  14. Phong SV, Koh LK (2007) Anaesthesia for robotic-assisted radical prostatectomy: considerations for laparoscopy in the Trendelenburg position. Anaesth Intensive Care 35(2):281–285

    CAS  PubMed  Google Scholar 

  15. Gagnon J, Poulin EC (1993) Beware of the Trendelenburg position during prolonged laparoscopic procedures. Can J Surg 36(6):505–506

    CAS  PubMed  Google Scholar 

  16. Mills JT, Burris MB, Warburton DJ, Conaway MR, Schenkman NS, Krupski TL (2013) Positioning injuries associated with robotic-assisted urologic surgery. J Urol 189(4):e350

    Google Scholar 

  17. Devarajan J, Byrd JB, Gong MC et al (2012) Upper and middle trunk brachial plexopathy after robotic prostatectomy. Anesth Analg 115(4):867–870

    Article  PubMed  Google Scholar 

  18. Parks BJ (1973) Postoperative peripheral neuropathies. Surgery 74(3):348–357

    CAS  PubMed  Google Scholar 

  19. Catalona WJ, Carvalhal GF, Mager DE, Smith DS (1999) Potency, continence and complication rates in 1,870 consecutive radical retropubic prostatectomies. J Urol 162(2):433–438

    Article  CAS  PubMed  Google Scholar 

  20. Warner MA, Martin JT, Schroeder DR, Offord KP, Chute CG (1994) Lower-extremity motor neuropathy associated with surgery performed on patients in a lithotomy position. Anesthesiology 81(1):6–12

    Article  CAS  PubMed  Google Scholar 

  21. Coppieters MW (2006) Shoulder restraints as a potential cause for stretch neuropathies: biomechanical support for the impact of shoulder girdle depression and arm abduction on nerve strain. Anesthesiology 104(6):1351–1352

    Article  PubMed  Google Scholar 

  22. Goskowicz R (1995) Use of shoulder restraints during arm abduction and steep Trendelenburg’s position. Anesthesiology 83(6):1377

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The strap is currently being made Pintler Medical Seattle WA. Cost; Reusable strap- $75.00, Set of foam $9.00 (1 cross chest, 2 shoulder pieces and 2 hip pieces). All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Conflict of interest

Felix L. Badillo, Gary Goldberg, Genri Pinkhasov, Christian Badillo, and Raymond C. Sultan declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Raymond C. Sultan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Badillo, F.L., Goldberg, G., Pinkhasov, G. et al. Secure patient positioning using Badillo/Trendelenburg restraint strap during robotic surgery. J Robotic Surg 8, 239–243 (2014). https://doi.org/10.1007/s11701-014-0459-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11701-014-0459-y

Keywords

Navigation