Figure 56.1
Prior to enter the O.R. the patient is invited to wear compressive long antithrombotic socks, that will left in place for the following 2 days. Gel or foam pads are positioned under the calves and knees to further reduce compressive complications
Over the surgical table an air warmed inflatable antidecubitus disposable mattress is positioned (Kanmed Warmcloud – Kanmed – Bromma, Sweden). The advantage of this medical device is to properly warm the patient during the surgical procedure, ameliorating the hemodynamic conditions during pneumoperitoneum and Trendelenburg position. Moreover, the antidecubitus property of the system reduces the risk of pressure marks and local tissue injury (Fig. 56.2).
Figure 56.2
The air warmed inflatable antidecubitus disposable mattress is positioned over the surgical bed and the adequate temperature settled
The patient is then positioned on the surgical bed in a supine position, properly supporting with gel or foam cushions calves and popliteal cavity in order to further avoid the risk of neurological compression or excessive traction (Fig. 56.2).
After anesthesia induction, a proper designed and custom made cushion (Fig. 56.3) is positioned to support the head and the shoulders of the patient in order to spread the load of the body during Trendelenburg position and avoid any potential compression or injury of the brachial plexus at the level of the shoulders (Fig. 56.4).
Figure 56.3
The custom made cushion specifically designed to support the head of the patient
Figure 56.4
The spread of the load of the body of the patient avoiding any risk for brachial plexus damage is clearly evident with the patient in Trendelenburg position
With the goal of protecting the hands of the patient and avoid any risk of nervous compressions with potential dramatic sequelae, an examination rubber glove filled with air is positioned on both sides of the patient in a “shacking hand” fashion (Fig. 56.5).
