Annals of Coloproctology

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Benign proctology,Surgical technique

Lithotomy versus prone position for perianal surgery: a randomized controlled trial: Pankaj Kumar, Tushar S. Mishra, Siddhant Sarthak, Prakash Kumar Sasmal; Ann Coloproctol. 2022;38(2):117-123. Published online June 7, 2021; DOI: https://doi.org/10.3393/ac.2020.12.16

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Purpose
Studies objectively comparing lithotomy and prone positions regarding surgeon comfort, ergonomics, patient comfort, and position related complications are scarce.
Methods
The patients posted for surgery of either fistula in ano, hemorrhoids, or were included in this study. Subjective Mental Effort Questionnaire (SMEQ) and Local Experienced Discomfort (LED) scale were used to score the level of mental and physical stress among the operating surgeon, assistants, and the scrub nurse. Other parameters studied were the exposure of the operative site, patient comfort level, and position-related complications.
Results
Thirty patients were operated in each position. Mean±standard deviation of jackknife prone vs. lithotomy surgeon SMEQ score (15.6±10.4 vs. 107.0±11.5, P<0.05) and LED score (1.8±1.5 vs. 6.7±0.5, P<0.05) were found to be statistically significant. Prone vs. lithotomy assistant SMEQ score (29.1±13.1 vs. 100.6±8.7, P<0.05) and LED score (4.6±1.1 vs. 7.4±0.8, P<0.05) were also found to be statistically significant. SMEQ (10.0±0.0 vs. 20.6±2.5, P<0.05) and LED scores (1.1±0.3 vs. 3.3±0.5, P<0.05) of scrub nurses and LED scores (2.5±0.5 vs. 6.3±0.7, P<0.05) of patients were also statistically significant. Exposure of the operative site was significantly better in the prone position (5.0 vs. 2.1, P<0.05).
Conclusion
Significantly better SMEQ, LED, and exposure score suggests the superiority of jackknife prone position over the lithotomy in terms of significantly less mental and physical stress to the operating surgeon, assistant, and scrub nurse; better ergonomics, and excellent exposure.

Citations

Citations to this article as recorded by

A scoping review of participant reported outcome measures assessed during live and simulated surgical procedures
Aaron K. Budden, Sophia Song, Amanda Henry, Claire E. Wakefield, Jason A. Abbott
The American Journal of Surgery.2025; 240: 116131. CrossRef
A comparative study of prone split-leg position and lithotomy position in posterior uterine myomectomy by transvaginal natural orifice transluminal endoscopic surgery
Yayu Zhou, Yonghong Lin, Dingyu Xu, Li He, Lu Huang
BMC Women's Health.2025;[Epub] CrossRef
Latest Research Trends on the Management of Hemorrhoids
Sung Il Kang
Journal of the Anus, Rectum and Colon.2025; 9(2): 179. CrossRef
A scoping review of cognitive load assessment tools suitable for clinicians performing REBOA
Codey Simmons, Robbie Lendrum, Zane Perkins, Gareth Grier, Max Marsden
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2025;[Epub] CrossRef
Vaginal natural orifice transluminal endoscopic surgery (vNOTES) in myomectomy: a novel minimally invasive technique review
Liufeng Xu, Jiaying Tao, Jigang Jia, Yonghong Lin, Li He
Archives of Gynecology and Obstetrics.2025;[Epub] CrossRef
Jackknife versus Lithotomy Position for Hemorrhoidectomy Surgery: A Randomized Controlled Trial
Sina Ghasemi, Behzad Imani, Alireza Jafarkhani, Ashkan Karimi, Ali Yamini
Scientific Journal of Kurdistan University of Medical Sciences.2024; 29(5): 76. CrossRef
A Randomized Controlled Comparative Study of the Three Over-Bed Techniques for Positioning and Repositioning the Lithotomy Position While Using Stirrups
Ling-Ling Zhang, Zhi-Fang Luo, Guang-Jing Yang
Journal of Multidisciplinary Healthcare.2023; Volume 16: 4255. CrossRef
Transvaginal repair of vesicouterine fistulae: our experience of three cases
Mingxin Cao, Junlong Zhang, Yu Chen, Yueyou Liang
International Urogynecology Journal.2022; 33(3): 737. CrossRef
Human factors in pelvic surgery
Matthew M. Symer, Deborah S. Keller
European Journal of Surgical Oncology.2022; 48(11): 2346. CrossRef

Short-term Outcomes of an Extralevator Abdominoperineal Resection in the Prone Position Compared With a Conventional Abdominoperineal Resection for Advanced Low Rectal Cancer: The Early Experience at a Single Institution: Seungwan Park, Hyuk Hur, Byung Soh Min, Nam Kyu Kim; Ann Coloproctol. 2016;32(1):12-19. Published online February 29, 2016; DOI: https://doi.org/10.3393/ac.2016.32.1.12

6,959 View
45 Download
11 Web of Science
10 Citations

Abstract PDF

Purpose

This study compared the perioperative and pathologic outcomes between an extralevator abdominoperineal resection (APR) in the prone position and a conventional APR.

Methods

Between September 2011 and March 2014, an extralevator APR in the prone position was performed on 13 patients with rectal cancer and a conventional APR on 26 such patients. Patients' demographics and perioperative and pathologic outcomes were obtained from the colorectal cancer database and electronic medical charts.

Results

Age and preoperative carcinoembryonic antigen (CEA) level were significantly different between the conventional and the extralevator APR in the prone position (median age, 65 years vs. 55 years [P = 0.001]; median preoperative CEA level, 4.94 ng/mL vs. 1.81 ng/mL [P = 0.011]). For perioperative outcomes, 1 (3.8%) intraoperative bowel perforation occurred in the conventional APR group and 2 (15.3%) in the extralevator APR group. In the conventional and extralevator APR groups, 12 (46.2%) and 6 patients (46.2%) had postoperative complications, and 8 (66.7%) and 2 patients (33.4%) had major complications (Clavien-Dindo III/IV), respectively. The circumferential resection margin involvement rate was higher in the extralevator APR group compared with the conventional APR group (3 of 13 [23.1%] vs. 3 of 26 [11.5%]).

Conclusion

The extralevator APR in the prone position for patients with advanced low rectal cancer has no advantages in perioperative and pathologic outcomes over a conventional APR for such patients. However, through early experience with a new surgical technique, we identified various reasons for the lack of favorable outcomes and expect sufficient experience to produce better peri- or postoperative outcomes.

Citations

Citations to this article as recorded by

Abdominoperineal Resection in Prone Versus Supine Position: A Systematic Review and Meta-Analysis
Bernardo Fontel Pompeu, Eric Pasqualotto, Beatriz D'Andrea Pigossi, Matheus Reginato Araujo, Lucas Monteiro Delgado, Lucas Soares de Souza Pinto Guedes, Sergio Mazzola Poli de Figueiredo, Fernanda Bellotti Formiga
Journal of Laparoendoscopic & Advanced Surgical Techniques.2025; 35(3): 224. CrossRef
Management of left-sided malignant colorectal obstructions with curative intent: a network meta-analysis
Tyler McKechnie, Jeremy E. Springer, Zacharie Cloutier, Victoria Archer, Karim Alavi, Aristithes Doumouras, Dennis Hong, Cagla Eskicioglu
Surgical Endoscopy.2023; 37(6): 4159. CrossRef
Prone Versus Supine Position in Abdominoperineal Resection: Outcomes in the Laparoscopic Era
Cecilia Ferrari, Carmen Martinez Sanchez, Jesus Bollo, Pilar Hernandez, Lorena Cambeiro, Claudia Codina, Eduardo Targarona
Journal of Laparoendoscopic & Advanced Surgical Techniques.2021; 31(4): 382. CrossRef
Surgical Treatment of Low-Lying Rectal Cancer: Updates
Cristopher Varela, Nam Kyu Kim
Annals of Coloproctology.2021; 37(6): 395. CrossRef
Perioperative and oncological outcomes of abdominoperineal resection in the prone position vs the classic lithotomy position: A systematic review with meta‐analysis
Jose Wilson B. Mesquita‐Neto, Hassan Mouzaihem, Francisco Igor B. Macedo, Lance K. Heilbrun, Donald W. Weaver, Steve Kim
Journal of Surgical Oncology.2019; 119(7): 979. CrossRef
Prone Compared With Lithotomy for Abdominoperineal Resection: A Systematic Review and Meta-analysis
Tyler McKechnie, Yung Lee, Jeremy E. Springer, Aristithes G. Doumouras, Dennis Hong, Cagla Eskicioglu
Journal of Surgical Research.2019; 243: 469. CrossRef
Perineal Wound Complications After Extralevator Abdominoperineal Excision for Low Rectal Cancer
Jia Gang Han, Zhen Jun Wang, Zhi Gang Gao, Guang Hui Wei, Yong Yang, Zhi Wei Zhai, Bao Cheng Zhao, Bing Qiang Yi
Diseases of the Colon & Rectum.2019; 62(12): 1477. CrossRef
Critical and Challenging Issues in the Surgical Management of Low-Lying Rectal Cancer
Aeris Jane D. Nacion, Youn Young Park, Seung Yoon Yang, Nam Kyu Kim
Yonsei Medical Journal.2018; 59(6): 703. CrossRef
EXTRALEVATOR ABDOMINOPERINEAL EXCISION OF THE RECTUM: SHORT-TERM OUTCOMES IN COMPARISON WITH CONVENTIONAL SURGERY
R. A. Murashko, I. B. Uvarov, E. A. Ermakov, V. B. Kaushanskiy, R. V. Konkov, D. D. Sichinava, B. N. Sadikov
Koloproktologia.2017; (4): 34. CrossRef
Extralevator Abdominoperineal Resection in the Prone Position
Young Jin Kim
Annals of Coloproctology.2016; 32(1): 1. CrossRef

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