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Fritsch Position – Gynecological Surgical Positioning

The Fritsch position is a gynecological patient positioning technique used during pelvic and abdominal surgical procedures, allowing optimal surgical access to the pelvic region.

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Things worth knowing about "Fritsch Position"

The Fritsch position is a gynecological patient positioning technique used during pelvic and abdominal surgical procedures, allowing optimal surgical access to the pelvic region.

What Is the Fritsch Position?

The Fritsch position is a specialized patient positioning technique used in gynecology and obstetrics. It was named after the German gynecologist Heinrich Fritsch and is designed to optimally position the patient for surgical procedures involving the pelvis, perineum, and lower abdomen. The Fritsch position belongs to the group of modified lithotomy positions and is widely used in both vaginal and abdominal gynecological surgery.

Technique and Setup

In the Fritsch position, the patient lies on their back. The legs are placed in stirrups or leg holders, elevated, slightly abducted, and externally rotated. The buttocks are positioned at or slightly beyond the lower edge of the operating table to provide the surgeon with unobstructed access to the perineum and vagina.

Key characteristics of this position include:

Supine position with elevated legs
Hip and knee joints are flexed
Legs are secured in stirrups or leg holders
Pelvis is slightly elevated
Optimal exposure of the surgical field in the lesser pelvis

Clinical Applications

The Fritsch position is used in a wide range of gynecological and obstetric procedures:

Vaginal surgeries such as colporrhaphy (vaginal wall repair)
Hysterectomy via vaginal or abdominal approach
Laparoscopic procedures in the pelvic region
Diagnostic and operative hysteroscopy
Perineal reconstruction and pelvic floor surgery
Urinary incontinence procedures such as TVT (tension-free vaginal tape)
Certain obstetric delivery situations

Advantages

Compared to other lithotomy positions, the Fritsch position offers several clinical benefits:

Simultaneous access to both the abdomen and perineum
Facilitates combined vaginal-abdominal procedures
Allows the use of assistive instruments from both sides
Improved intraoperative visualization of the surgical field

Risks and Complications

As with any lithotomy-type positioning, there are risks that must be minimized through careful technique:

Nerve injuries: Pressure on the common peroneal nerve or femoral nerve from improper leg positioning can cause nerve damage
Compartment syndrome: Prolonged elevation of the legs may increase pressure in the lower leg muscles
Thrombosis risk: Reduced venous return from elevated legs increases the risk of deep vein thrombosis
Pressure injuries: Pressure sores on the heels, calves, and knees due to insufficient padding
Hemodynamic changes: Lowering the legs after surgery can cause a sudden drop in blood pressure

Nursing and Anesthesia Considerations

Surgical nurses and anesthesia professionals share responsibility for the safe execution of the Fritsch position. Important points include:

Adequate padding of all pressure points prior to positioning
Simultaneous lifting and lowering of both legs to avoid spinal stress
Regular monitoring of the position throughout the procedure
Documentation of positioning duration
Patient education regarding possible postoperative positioning-related discomfort

Comparison with Similar Positions

The Fritsch position is closely related to the classic lithotomy position and the Trendelenburg position. Unlike the standard lithotomy position, the Fritsch position involves a specific table inclination and enhanced pelvic exposure. In modern surgical practice, it is frequently combined with Trendelenburg tilting to displace bowel loops away from the pelvis and improve the operative view.

References

Lenz, S. et al.: Operative Gynecology. Georg Thieme Verlag, Stuttgart, 2019.
Stauber, M., Weyerstahl, T.: Gynecology and Obstetrics. Georg Thieme Verlag, 4th edition, 2013.
German Society of Gynecology and Obstetrics (DGGG): Guidelines for Operative Gynecology. www.dggg.de, accessed 2024.

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