Head-Down Tilt Lithotomy Position and Well-Leg Compartment Syndrome: An International Survey of Current Practice

Chukwuemeka C Uzoma; Anthony Ian Shepherd; Zoe Saynor; Jim S Khan; Guglielmo Niccolò  Piozzi; Rauand Duhoky; Christopher Askew; M Mahir Ozmen; Thierry R F Middleton; Shamsul Masum; Maria-Christina Perissiou; HDTL-WLCS Global Survey Collaborating Group

doi:10.1111/codi.70134

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Head-Down Tilt Lithotomy Position and Well-Leg Compartment Syndrome: An International Survey of Current Practice

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Head-Down Tilt Lithotomy Position and Well-Leg Compartment Syndrome: An International Survey of Current Practice

Chukwuemeka C Uzoma, Anthony Ian Shepherd, Zoe Saynor, Jim S Khan, Guglielmo Niccolò Piozzi, Rauand Duhoky, Christopher Askew, M Mahir Ozmen, Thierry R F Middleton, Shamsul Masum, …

Colorectal Disease , Vol.27(6), pp.1-9

2025

DOI: https://doi.org/10.1111/codi.70134

PMCID: PMC12144681

PMID: 40481693

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Abstract

compartment syndrome

global survey

Lloyd-Davies

perioperative practices

prevention and management

robotic surgery

Aim Well-leg compartment syndrome (WLCS) is a serious complication of prolonged surgery in the head-down tilt lithotomy (HDTL) position associated with increased postoperative morbidity and mortality. However, there is a lack of awareness and clinical guidance regarding prevention of WLCS. The aim of this study was to assess current HDTL-related practices and occurrence of WLCS among a global cohort of clinicians. Method An international online survey of clinicians was conducted between July and December 2023. Data analysis involved descriptive statistics, machine learning techniques and qualitative content analysis. Results A total of 595 clinicians from 71 countries and 14 specialities participated. Most (98%) reported routine use of HDTL, 27% of whom did not implement any preventive strategies. ‘Leg rest’ was the most reported preventive measure (41%), commonly initiated after 2 or 3 h of HDTL (79%), for 10–15 min (56%). Overall, 170 cases of WLCS were reported by 21% of respondents. The majority reported unilateral WLCS (81%) following a laparoscopic procedure (63%) performed in HDTL (64%). Only 28% of respondents discussed WLCS during consent for operations in HDTL. Machine learning identified ‘duration of uninterrupted HDTL’ as a positive predictor of the occurrence of WLCS (p < 0.001). Content analysis demonstrated that clinician perspectives and practices regarding WLCS are significantly influenced by personal experience, mostly due to a poor evidence base and lack of standardized institutional policies. Conclusion Perioperative practices during procedures in HDTL vary substantially, and are primarily informed by clinician experience and preferences. There is a need for evidence-based consensus on best practices to enhance safety during procedures in HDTL.

Details

Title: Head-Down Tilt Lithotomy Position and Well-Leg Compartment Syndrome: An International Survey of Current Practice
Authors: Chukwuemeka C Uzoma - University of Portsmouth
Anthony Ian Shepherd - University of Portsmouth
Zoe Saynor - University of Southampton
Jim S Khan - Portsmouth Hospitals NHS Trust
Guglielmo Niccolò Piozzi - Portsmouth Hospitals NHS Trust
Rauand Duhoky - Portsmouth Hospitals NHS Trust
Christopher Askew - University of the Sunshine Coast, Queensland, School of Health - Sports & Exercise Science
M Mahir Ozmen - Sapienza University of Rome
Thierry R F Middleton - University of Portsmouth
Shamsul Masum - University of Portsmouth
Maria-Christina Perissiou (Corresponding Author) - University of Portsmouth
HDTL-WLCS Global Survey Collaborating Group (Research Group)
Additional notes: Presented in abstract form to the European Society of Coloproctology Conference, Thessaloniki, Greece, 25–27 September 2024; published in the Conference Abstracts Book ePosters: Colorectal Disease 2024;26(S2):31–388 PO298 (https://doi.org/10.1111/codi.17125).
Publication details: Colorectal Disease , Vol.27(6), pp.1-9
Publisher: Wiley-Blackwell Publishing Ltd.
Date published: 2025
DOI: 10.1111/codi.70134
ISSN: 1463-1318
PMID: 40481693; PMC12144681
Copyright note: © 2025 The Author(s). Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Data Availability: The dataset utilised in the preparation of this manuscript is available on the Open Science Framework (10.17605/OSF.IO/YR7KD).
Grant note: This project was funded by the Faculty of Science and Health, University of Portsmouth.
Organisation Unit: Healthy Ageing Research Cluster; Cancer Research Cluster; School of Health - Sports & Exercise Science
Language: English
Record Identifier: 991115152202621
Output Type: Journal article

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