Make Surgeons' Position More Comfortable.

Recent years have witnessed an astonishing increase in the number of women requesting female genital plastic surgeries (FGPS).[1,2] Our center conducted FGPS on over 300 patients every year. Patients who presented for combined procedures were not rare,[1] and sometimes they wanted 3 or more FGPS done at once (eg, labioplasty + clitoral prepuce reduction + vaginal rejuvenation + hymenoplasty), which took surgeons significantly more time to perform.[1] Also, it is common for surgeons to perform FGPS for 3–4 patients consecutively on a daily basis.

The highest surgical performances require good physical condition, which ensures focus, a firm, steady, controlled hand, and endurance.[3] However, while performing FGPS, the surgeons’ arms have to keep hanging in the air, without any support, for a very long duration, constantly resulting in serious ache in the surgeons’ arms, shoulders, and back, which eventually may do harm to the patients. Therefore, a comfortable position is of high importance for surgeons performing FGPS.

During FGPS, the gynecological lithotomy position is used to place patients: leg plates of the OR table are removed, with patient’s legs positioned in leg holders.[1,5] FGPS is within the realm of plastic surgery[1] and many procedures are quite different from classic gynecologic operations. To explore a comfortable position for surgeons, we refine the accessories of the OR table (Maquet Getinge Group, Rastatt, Germany): Simply rotate the 2 pieces of leg plates about 70° outward each (Fig. 1, black arrow), rather than removing them, so surgeons can put their elbows on it without compromising their workspace, which will hugely relieve their tiredness and backache while performing FGPS (Fig. 2). Dr. Goodman seemed to have also suffered from discomfort while conducting FGPS, and he used a smart technique of pulling out the shelf from the end of the back table (extension shelf), on which surgeons could rest their forearms during the procedure, as well as place surgical instruments on it.[4]

Fig. 1.

Refinement of the accessories of OR table for surgeons’ comfort. Rotate the 2 pieces of leg plates about 70° outward each (black arrow), rather than removing them. The white arrow refers to sacral cut-out for drainage.

Fig. 2.

The surgeon can put his elbows on the leg plates rather than hanging his arms in the air for a long duration while performing FGPS. Of note, since most FGPS are minor invasive operations performed in out-patient OR, the surgeon just scrubbed his arms and hands, and wore sterile gloves. In this case, although the leg plates have sterile drapes on top, they are just for resting arms. Whenever hands come into contact with the drapes, gloves should be exchanged.

However, we still prefer our method, because instead of having the extension shelf come from the midline, our support plates for arms are from both sides, preserving the classic gynecologic back plate’s sacral cut-out (Fig. 1 white arrow), which has a drainage effect.[5] FGPS patients are usually under local infiltration anesthesia, and abundant anesthetics will be injected to assure analgesia in this very sensitive area.[1,4] Therefore, excess anesthetics will flow out when cutting is commenced during FGPS. Moreover, there might be body fluids from the urethra, vagina, and anus during surgery,[5] and sometimes disinfection has to be done again after skin preparation and draping. Without efficient drainage, the disinfectant, body fluids, and anesthetics may dampen the sterile drapes on the extension shelf,[4] which poses a risk to the asepsis of both the shelf and the surgical instruments on it. Thus, we believe it is necessary to keep the sacral cut-out area clear to ensure the asepsis during surgery as well as a dry and warm condition for patients’ buttock.[5]

Our refinement is very simple to execute, without any extra cost, exactly conforming to asepsis during surgery, but preventing surgeons’ uncomfortable position while conducting FGPS, which it is hoped, will improve surgical performance. Thus, we believe it is well worthy of wide application.

STATEMENT OF CONFORMITY

All the content in this article conforms to the Helsinki Declaration.