An Alternate Approach to Using Candy Cane Stirrups in Vaginal Surgery.

BACKGROUND: Candy cane stirrups are widely used for vaginal surgery because they provide sufficient operating space. When placed in the standard perpendicular alignment, however, these stirrups cause excessive flexion, abduction, and external rotation of the thigh, which may injure the femoral, lateral femoral cutaneous, sciatic, and common peroneal nerves.

TECHNIQUE: We corrected this deficiency by positioning the stirrups parallel to the operating table, just above and tilting slightly toward its lower break. After placing the patient in stirrups, we inserted a double-layer foam pad between her knee and the stirrup and adjusted the height of each stirrup until both thighs were flexed 90 degrees and both knees flexed 100 degrees. We then pushed the L-shaped lower stirrup toward or pulled it away from the operating table until each thigh was vertical, with minimal abduction or adduction. Finally, we rotated the curved upper stirrups medially until each leg was pointing slightly laterally.

EXPERIENCE: Of 1,576 vaginal cases, there were eight (0.5%) instances of postoperative sensory neuropathy, which usually involved the lateral femoral cutaneous nerve.

CONCLUSION: This simple modification to the candy cane stirrups allows placement of patients in dorsal lithotomy with their legs in an anatomically and neurologically neutral position.