Positioning Considerations for Patients With Lower Extremity Amputees in Minimally Invasive Gynecologic Surgery

INTRODUCTION: Patients with lower extremity amputations present unique challenges for positioning during minimally invasive gynecologic surgery. Appropriate positioning is critical to maintain surgical exposure while minimizing risks such as nerve injury, pressure ulcers, and hemodynamic instability. However, current literature lacks guidance on best practices for patients with lower extremity amputations. OBJECTIVE: The objective of this paper is to describe operative positioning strategies for patients with lower extremity amputations undergoing minimally invasive gynecologic procedures. METHODS: This case report presents two patients with lower extremity amputations who underwent minimally invasive gynecologic surgery at a tertiary academic center. The first case involved a patient with a left below-knee amputation undergoing hysteroscopic and robotic-assisted myomectomy. Her amputated leg was stabilized using heel-protector foam and secured to an Allen stirrup with an Ace bandage. The second case involved a patient with a right above-knee and left below-knee amputation undergoing total laparoscopic hysterectomy. A split-leg Maquet bed was used to allow modified lithotomy positioning without the use of prosthetics. RESULTS: Both surgeries were completed without intraoperative or postoperative complications related to positioning or the patients’ amputations. CONCLUSIONS: These cases highlight adaptable positioning techniques for gynecologic surgery in patients with lower extremity amputations. Key considerations include the level of amputation, presence or absence of prosthetics, and potential contractures. Individualized approaches are necessary to optimize surgical access and minimize perioperative risk in this patient population.Figure 1Figure 2Figure 3