Laparoscopic advanced surgery has been taught in many institutions in the United States. Initially,
proctoring for the laparoscopic technique was performed by European surgeons; therefore, the lithotomy
position was suggested as the preferred approach. Many American and European surgeons
have adopted the supine position.
Laparoscopy initially entered the clinical realm in the field of gynecology. Albert Decker, at the
Knickerbocker and Gouverneur Hospital in New York, performed culdoscopy as early as 1928. This
was done in the "knee-chest" position without the use of pneumoperitoneum. Raoul Palmer, at the
Hôpital Broca in Paris, popularized "colposcopie," utilizing pneumoperitoneum, with the patient in
the lithotomy position. Laparoscopy then advanced in Europe to the general surgery arena. As a
result, patient positioning for laparoscopic procedures in Europe was performed in what is now referred
to as the French position (i.e., lithotomy). Many of these procedures are modified to a side
approach, or American position, when performed in the United States.
There is a clear association between the dorsal lithotomy position and the development of postoperative
compartment syndrome. Compartment syndrome occurs when elevated pressure in an osteofascial
compartment compromises local perfusion, and often results in neurovascular damage
and permanent disability. Many centers have adopted the lithotomy position for their laparoscopic
advanced procedures. At our institution, however, we prefer all procedures be performed in the
American position (patient supine and the surgeon at the side of the patient), since this resembles
the position used for other, open surgeries. The advantage of this approach is that it eliminates the
risks associated with placement of the patient in the lithotomy position.
