Patient Position in Operative Endoscopy

Abstract

It is well known by surgeons that patient positioning is fundamental to exposing the organs when performing an operation via laparoscopy, as gravity can help move the organs and facilitate the exposure of the surgical site. But is it also important for endoscopic procedures? This paper examines various types of endoscopic operations and addresses the issue of the patient's position. The patient's position can be changed not only by rotating the patient along the head-toe axis but also by tilting the surgical bed, as is undertaken during laparoscopic surgical procedures. In particular, it is useful to take into account the effect of gravity on lesion exposure, tumour traction during dissection, crushing by body weight, risk of sample drop, risk of damage to adjacent organs, and anatomical exposure for procedures with radiological support. The endoscopist should always keep in mind the patient's anatomy and the position of the endoscope during operative procedures, not limited to considering only intraluminal vision.

Keywords: ERCP; ESD; POEM; colonoscopy; operative endoscopy; patient position; prone; supine.

Figure 1

Study search and selection diagram.

Figure 2

Trendelenburg.

Figure 3

Anti-Trendelenburg position.

Figure 4

Left lateral position plus 15° angle rotation.

Figure 5

Changing the patient’s position can help expose the source of bleeding. In the first position, the blood covers the lesion, preventing its endoscopic visualisation. By rotating the patient from the left lateral position to the right lateral position, the blood moves, and the lesion becomes visible.

Figure 6

Endoscope positioning in the left lateral decubitus position: the tip of the endoscope falls to the greater gastric curvature. This leads the endoscope to naturally position itself on the lesion.

Figure 7

Endoscope positioning in the supine decubitus position: the tip of the endoscope falls to the posterior gastric wall.