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Tilt Tables and Positioners

The best retractor is for endoscopic surgery is gravity. Exposure by gravity is superior to any self-retaining retractor or assistant’s hands used during traditional surgery.

Gravity’s advantage is obtained by tilting the patient into a Trendelenburg (head down) position, reverse Trendelenburg (head up) position, right lateral recumbency, or left lateral recumbency.

The appropriate position results in the surgical site being higher so that other viscus moves away from the surgical site. In general, rotation for Trendelenburg should not exceed 15 degrees as an excessive head-down position further complicates ventilation.

With patient secured to the table, the use of a positioner markedly improves the asepsis of the surgery. Rotation to lateral recumbency is very important when doing an ovariohysterectomy, ovarioectomy, adrenalectomy, and obtaining a medial iliac lymph node biopsy. Slight rotation can be helpful for pericardial resection, cholecystectomy, pancreatic biopsies, and gastropexy procedures.

Above: The DRE tilt table is one method for tilting the table to either lateral recumbency, to Trendelenburg (head down), or to reverse Trendelenburg position. This is done using the “joy stick”-style controls at the head of the table.

Above: The TT tilt positioner, designed and developed by the late Dr. Ty Tankersly, is secured to the top of the operating table. It was developed for laparoscopic ovarioectomies and spays as it can tilt left lateral to right lateral recumbency. The TT table is available from Storz.

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