A patient with severe thoracic kyphosis was safely operated on in the supine position using the Hug-U-Vac® surgical positioning system: A Case Report

The incidence of thoracic kyphosis has tended to increase with the growth of the aging population, making it challenging for patients with excessive curvature of the thoracic spine to lie in the supine position. We herein report the use of the Allen® Hug-U-Vac® surgical positioning system (Allen Medical, Acton, MA, USA) to secure the surgical field for abdominal surgery in a patient with severe thoracic kyphosis. The patient was a 92-year-old woman, 150 cm tall and weighing 37.5 kg, scheduled for emergency open abdominal surgery to treat a strangulated bowel obstruction caused by an incarcerated obturator hernia. The patient's excessive thoracic spine curvature made it difficult for her to maintain a supine position. A backrest was fashioned using the Hug-U-Vac®️, and general anesthesia was induced. After intubation, the upper body was splinted and stabilized in the Hug-U-Vac®️, and the operating table was tilted until the abdominal plane was nearly horizontal. Surgery was completed with no complications. In most cases, patients with excessive thoracic curvature can still maintain a supine position using pillows or cushions placed under the head or back. However, these supports may slip during surgery, potentially applying undue stress on the spine. The Allen® Hug-U-Vac® surgical positioning system, a “bean bag”-type positioner, uses proprietary vacuum technology to secure patients in a fixed and stable position throughout the surgery. We successfully managed a patient with severe thoracic kyphosis using this system, achieving both an optimal surgical field and proper body posture.