Patient Positioning for Laparoscopic Cholecystectomy: Reverse Trendelenburg with Left Lateral Tilt

Standard Position

Supine, Reverse Trendelenburg (head up 15–30°) + Slight Left Lateral Tilt (10–15°).

Physiologic Rationale

• Reverse Trendelenburg: Gravity retracts bowel/omentum caudally, exposing Calot’s triangle.
• Left Lateral Tilt: Shifts colon/fundus away from gallbladder fossa; improves ergonomics for surgeon standing on left.
• Combined: Optimal critical view of safety (CVS) exposure; reduces bile duct injury risk.

Sequence

1. Induction & intubation supine flat.
2. Positioning: beach chair / reverse T + left tilt (gel rolls, bean bag, or motorized table).
3. Secure: shoulder braces (cautiously—brachial plexus risk), footboard, arm tucking.
4. Prep & drape; confirm hemodynamics (reverse T ↓ venous return → hypotension risk).
5. Port placement: Optical (umbilical), epigastric, 2× RUQ.

Critical Safety Checks

• Pad all pressure points (heels, elbows, scapulae, peroneal nerve at fibular head).
• Ensure ET tube secure; re-verify breath sounds after tilt.
• Sequential compression devices (SCDs) + pharmacological VTE prophylaxis.
• Monitor for sliding (shoulder braces controversial; many use foam mattress + tape).

Post-Op

Return to supine flat before emergence. Assess for brachial plexus neuropraxia (shoulder brace complication).

This positioning is the global standard for laparoscopic cholecystectomy.