The usual position for surgery, called the dorsal recumbent position, is flat on the back.

One arm is positioned at the side of the table, with the hand placed palm down; the other is carefully positioned on an armboard to facilitate intravenous infusion of fluids, blood, or medications. This position is used for most abdominal surgeries except for surgery of the gallbladder and pelvis (see Fig. 19-3A).

The Trendelenburg position usually is used for surgery on the lower abdomen and pelvis to obtain good exposure by displacing the intestines into the upper abdomen. In this position, the head and body are lowered. The patient is held in position by padded shoulder braces (see Fig. 19-3B).

The lithotomy position is used for nearly all perineal, rectal, and vaginal surgical procedures (see Fig. 19-3C). The patient is positioned on the back with the legs and thighs flexed. The position is maintained by placing the feet in stirrups.

The Sims or lateral position is used for renal surgery. The patient is placed on the nonoperative side with an air pillow 12.5 to 15 cm (5 to 6 inches) thick under the loin, or on a table with a kidney or back lift (see Fig. 19-3D).