Landmark Study on Trendelenburg Positioning Techniques Published in the Journal of Gynecologic
The Journal of Gynecologic Surgery recently published Dr. John Nakayama’s landmark study comparing
Trendelenburg positioning techniques in minimally invasive surgery. The Pink Pad®
from Xodus Medical
emerged as a clinically preferable solution on multiple fronts:
- “Post-operative erythema (skin redness) was significantly less common in The Pink Pad® group…”
- “The Pink Pad® was associated with less postoperative pain…”
- “There was significantly less movement on the Pink Pad® at all anatomical landmarks…”
- “(Total additional operative time for) the Pink Pad® was found to be 37.1%... and 45.5%… faster than
the gel pad and the beanbag, respectively."
Dr. John Nakayama and his team of researchers designed and implemented the most complete study on
Trendelenburg positioning techniques in history. The study, published earlier this year in the Journal of
Gynecologic Surgery, is:
- The largest prospective randomized trial of Trendelenburg positioners in history
- The most scientifically in-depth, rigorous study of its kind
The study establishes the Pink Pad®
from Xodus Medical as a clinical “best practice.” Its findings help surgeons
and operating-room staff make more informed decisions regarding safe patient positioning.
Read the complete study
in the Journal of Gynecologic Surgery.
Partnering with AORN to Make Surgery Safer
Xodus Medical has partnered with AORN to create the official Tool Kit for the Prevention of Perioperative Pressure Injury. We are focused on providing unique, effective, and complete solutions for perioperative teams dedicated to safeguarding their patients against preventable, Hospital-Acquired Pressure Injuries (HAPIs).
All surgical patients are at risk for pressure injury development. Pressure injuries are a common problem that may significantly increase patients’ pain, recovery times, and the overall cost of healthcare delivery. The AORN Tool Kit will help perioperative RNs and other healthcare professionals prevent the development of pressure injuries in surgical patients. Included in the Tool Kit are evidence-based prevention strategies as well as tools that can be implemented and adapted to your perioperative setting.
about the AORN Tool Kit for the Prevention of Perioperative Pressure Injury.
Better Visualization, Faster: Introducing the See Sharp
The See Sharp from Xodus Medical delivers safer, faster, more thorough laparoscope cleaning, warming and defogging.
Achieve outstanding, long-lasting visualization at temperature safe for modern, robotic laparoscopes. Streamline cleaning exchanges with flexible, secure placement on any sterile field; including direct connection to both 5mm and 12mm trocars. Reduce instrument passing to-and-from the surgical site; decreasing SSI risk and improving efficiency. Designed to be compact, environmentally friendly and easy to store. Complete kits maximize value and feature innovative accessories, including full-length trocar swabs that minimize RSI risk.
The See Sharp: a Sharper View of Patient Safety! Learn more here!
New Product Alert: Face Shields Now Available!
Xodus Medical remains committed to meeting the needs of the healthcare community during this unprecedented public health challenge. We are excited to announce availability of our in-house produced Face Shields. We look forward to helping with this high-quality PPE solution. Our Face Shields provide clear, quality protection where it's needed most.
Details at a glance:
- Enhanced personal protection against infectious droplets, bodily fluids, contaminants, etc.
- Anti-glare, crystal clear lens
- Wearable with glasses/goggles and masks
- Secure elastic headband
- Comfortable: breathable and lightweight
- Available in multiple sizes
Our new Face Shields are available immediately. You can find more information here, contact your Xodus Medical representative, or send an email to email@example.com for further details, pricing, etc.
For Immediate Release: New Patient Positioning Solutions for the ICU!
Xodus Medical is committed to responding to the needs of our customers. Recent feedback related to patient-positioning challenges in the ICU have prompted us to develop a series of solutions for immediate release. Our PinkProtect™ Kits are designed to help ICU clinicians achieve their positioning, and overall patient safety goals.
These kits offer critical-care clinicians and patients:
- Proven, skin-friendly positioners designed to address the specific patient safety challenges of the Intensive Care Unit
- DermaProx Pink™ – a breathable, soft, moisture wicking material for the utmost protection against HAPI formation
- Supportive, high-density cores that help distribute pressure during lengthy patient positioning intervals
- Unique designs tailored to the specific requirements of ICU patient positioning
These kits are Made in the USA and available immediately. You can find more information here, contact your Xodus Medical representative, or send an email to firstname.lastname@example.org for further details, pricing, etc.
Xodus Thanks Healthcare Workers Everywhere
This new video utilizes content sourced directly from our customers. The purpose of this piece is to show appreciation for the efforts of the entire medical community. There is a silver lining in this challenging time: we have the opportunity to support truly good people. Those who have dedicated their life's work to improving the health and well-being of our own communities. Our customers mean the world to us both personally and professionally.
Xodus Takes Comfort to the Next Level in Prone Positioning - The ComfortFit™
Our new, ComfortFit™ Headrest for prone positioning features a soft, skin-friendly layer of DermaProx™ material that helps reduce skin redness and breakdown.
This specially designed material allows skin to breathe and prevents moisture build-up, protecting sensitive skin areas throughout even the longest surgical procedures. With an additional layer of supportive, high density foam, the patient’s head is held securely in a proper anatomical position. The ComfortFit's single-use design makes setup and clean up effortless; minimizing the risk of HAI. As with most Xodus Medical headrests, the ComfortFit is available as a standalone product or within our customizable, skin-friendly Surgical BackPack kits.
You can find more information on this product and Xodus's full line of specialty and general-purpose positioning products here or contact your Xodus Medical representative for a sample of product number 40766.
A Postless Approach to Better Patient Outcomes
A number of unique, patient-positioning related challenges are associated with orthopedic surgery. Due to this, Xodus Medical has been focusing on making orthopedic procedures
safer with a dedicated line of products designed to address: HAPI reduction
, nerve-damage prevention, procedure duration, cost, etc.
The release of the The Pink Hip Kit by Xodus Medical has been a game changing advancement in terms
of patient safety for hip procedures. It is a complete positioning system that eliminates both the need for a
perineal post and any associated risk of nerve injury to the perineum.1 Additionally, patented skin-friendly
materials are used to safeguard areas of the patient that are susceptible to Hospital Acquired Pressure
Independent studies done on this product have demonstrated better patient outcomes in the form of significantly reduced postoperative pain, improved recovery times, and overall patient satisfaction. Surgeons have reported that even challenging hip procedures can be performed more successfully, in less time, and with greater ease. The postless approach in combination with The Pink Hip Kit makes distraction safer by reducing traction time and force, while a greater range of motion and improved surgical access during allow for a more complete dynamic exam. Kits are available for a variety of table brands which allows the surgeon to utilize their existing equipment and techniques, making the transition to "postless" easy and economical.2
Here's what Associate Professor of Orthopedic Surgery at the Institute of Academic Medicine at Houston Methodist, Dr. Joshua Harris, had to say about The Pink Hip Kit in an interview:
"When you use the post between the legs, a large amount of pressure is applied to the perineum area that can be associated with skin injury and nerve injury and can happen as high as 30-35%. If you can eliminate the post, you can actually reduce that complication to the perineum down to 0%."
Even with heightened national attention, deaths resulting from opioid overdose, many of which are prescribed pain relievers, continue to have a devastating impact on communities, healthcare cost, and our economy overall. While individual states work to put opioid reduction plans into place, promoting harm reduction is a common goal within all of them.3 When discussing how The Pink Hip Kit reduces the need for Dr. Harris to prescribe pain medication for his patients he said this:
"With less pain, they were able to recover and get to therapy a little bit better and there was a zero percent incidence of any numbness or skin problems in their perineum and their inner thigh. We really try to get patients off of pain medications and any kind of opioid dependency within the first one to two weeks, so if you can reduce that early pain by using The Pink Hip Kit, then that is one of the biggest advances that we have in our hip preservation techniques because we can make our surgery safer and
make our surgery better."
1Mei-Dan O, Kraeutler MJ, Garabekyan T et al. Hip Distraction Without a Perineal
Post; A Prospective Study of 1000 Hip Arthroscopy Cases. AJSM. 2018;46(3):632–641
2Kollmorgen RC, Ellis T, Lewis BD, Harris JD. Achieving Post-Free Distraction in Hip Arthroscopy
With a Pink Pad Patient Positioning Device Using Standard Hip Distraction Tables. Arthroscopy Techniques: Technical Note. 2019; 8(4): 363-368.
3Integrated Healthcare Association. Focus Area: Opioids. Retrieved from:
Is it Time to Bag Bean Bags?
The Pink Pad makes Trendelenburg easier, safer and more economical.
Pamela Goss, BSN, RN, CNOR, San Diego
Most of us no longer use dial-up internet, 8-track tapes, floppy disks or slide rules. We no longer own rotary phones or VHS video players. Is it time to consign bean bags to the same scrap heap? At least for Trendelenburg positioning, I think the answer is yes. There's a much safer, more efficient, more economical solution available -the Pink Pad from Xodus Medical. I know of what I speak. As recently as a couple years ago, I was a seasoned member of the bean bag brigade. As robotics coordinator at the University of California-San Diego medical center, I used them all the time to secure GYN, urology and colon patients in Trendelenburg. But I was never a fan.
- Especially with heavier patients, bean bags sometimes just aren't stable;
- Bean bags can have hidden pinholes that prevent suction, a major problem if the patient is already intubated. During long cases they can also lose suction and pancake, threatening the patient's stability;
- Their use sometimes results in skin ulcers and nerve damage. That's not only bad care; it can be a costly "never event";
- They have to be cleaned between cases, slowing room turnover because the surface needs to air dry;
- They are potential cross-contamination sources. I've seen bodily fluids on reusable bean bags more than once.
Fortunately, bean bags are no longer necessary for Trendelenburg. I found that out the day we tried our first pink pad.
When I first saw it, I was dubious. How would this colorful flat pad perform the function of a form-fitting bean bag? I watched in amazement as the Pink Pad held an obese patient like glue on a table tilted 40 degrees. Since then I've learned:
- It's incredibly comfortable. It molds to the patient's contours and grips the skin while reducing pressure and shear. The high-tech Pink Pad material feels like the viscoelastic gel pads on expensive beds.
- With bean bags, if the patient sweats, there's nowhere for the liquid to go, and that can exacerbate skin breakdown. The Pink Pad material wicks away moisture, helping to prevent ulcers. The material is so skin-friendly that I sometimes cut off the corners and use the scraps to cushion the hard parts of the IV.
- Once you're in tilt, there's no pressure on the head, neck or shoulders and no worries about pressure or nerve injuries there.
- Set up is less than a minute, saving us 5 to 6 minutes per procedure. When you consider that OR time can cost as much as $80 per minute, the Pink Pad pays its own way and then some.
- The Pink Pad is single-use, so there's no risk of cross-contamination.
Remember DVD rental stores? They were great in their time, but now that time is over. In my mind, bean bags are in the same category. It's time to move on. When you need to position patients in Trendelenburg, do your patients, your facility and your staff a solid and "think pink." You'll be glad you did.
Ms. Goss is Robotics Coordinator at UCSD Thornton Hospital in La Jolla, Calif.
Positioning your Way to Better Economic Outcomes
There’s a better, safer, more economical way to do Trendelenburg.
Joe X. Jung, RN, MBA, CNOR Los Angeles
In this era of austerity, we all need to work to contain surgical case costs. But as we do so, we need to keep the big picture in mind.
Yes, price is important, but only as it relates to the value or worth of the product. A cheap product can end up being very expensive.
To explain what I mean, consider robotic surgery supply costs.
Traditionally, we’ve used disposable egg-crate foam combined with reusable shoulder braces or beanbags to keep patients stable in steep Trendelenberg. On the surface, this is a very inexpensive strategy, with an up-front cost of maybe $30 or so. But a deeper look reveals that this seemingly cheap solution actually results in very high costs—well over $500 per case on average. Here’s why:
- The cost of slippage. In many cases, patients slip enough to force the OR team to undock the robot and sometimes retuck the arms and reposition the stirrups, taking 15 minutes or more. If OR time costs $100/minute1, that adds up to at least $1,500. For example, if this occurs in one case out of 10, slippage adds at least $150 to the cost of each case on average. Of course if skin shear or port trauma occurs during the slip, the cost is even higher.
- The cost of pressure injuries (PIs). PIs are all too common with the traditional approach. In our facility, we find that shoulder braces result in shoulder pain for at least 1 in 4 patients, while beanbags result in skin issues for about 1 in 5. Let’s say these develop into a full-blown PI once every 100 cases. Each pressure injury costs a facility $43,1802. That means PIs raise the cost of the traditional approach by another $432 per case.
- Legal/reputational costs. At least 17,000 pressure injury patients file lawsuits every year. It’s the second most common claim after wrongful death.3 Even a successful defense of a malpractice suit costs $50,000 according to AMA. When the case involves use of products like egg-crate foam for unintended/unapproved purposes, it may be even harder to defend. Such cases may also sour patients and surgeons on your facility because of Never Events there. What’s the cost of that?
There’s a far superior solution on the market. It’s called the Pink Pad, from Xodus Medical. This shape-conforming pad grips patients firmly in Trendelenberg without shoulder braces or bean bags. The material is designed to wick away moisture and preserve the skin’s integrity. Its up-front cost may be slightly higher, but its value dwarfs that of other options such as foam and bean bags. It’s truly a “no brainer”—better for the patient and better for facility economics.
More than 90 percent of an iceberg rests below the waterline. OR supply costs can be similarly deceptive. Just a reminder to keep your eyes open and the big picture in mind as you steer your facility through the challenging times ahead.
Mr. Jung is Department Administrator, Perioperative Services at Kaiser Permanente Los Angeles Medical Center.
1 Girotto JA, Koltz PF, Drugas G: Optimizing your operating room: Or, why large, traditional hospitals don’t work. Intl. J. Surg., Volume 8, Issue 5, 2010, pp 359-367.
2 Agency for Healthcare Quality and Research
Switching to BackPacks dramatically reduced the incidence of PIs in this facility
Ask surgical professionals to name the most important advances of the last 5 years and most will say 4K video, lasers or maybe the use of robots. Although these are groundbreaking advancements in healthcare, the product that has changed patient outcomes for our service is none of the above. It’s a seemingly simple set of single-use pads and positioners called Surgical BackPacks.
Trust me: If you do prone positioning, it is a flat-out game-changer. Trial it. You’ll see.
At our hospital, we do about 60 neuro cases a week, with many in prone position. Pressure injuries can often be a big problem with this group. The cases are time intensive. Comorbidities are common, and the OR environment can be unfriendly to the skin.
For years, the tools we had to help us were limited. We had table covers designed to protect the equipment, not necessarily the patient, and low-tech foam pads inappropriate for prolonged skin contact. Back then, it was not uncommon to see one to two pressure-related events per week, such as abdominal skin tears, persistent erythema and/or blisters. Then, two years ago, we had an opportunity to trial Xodus Medical Surgical BackPacks. That’s when our skin integrity outcomes began to improve.
BackPacks are extremely convenient custom kits for prone positioning. Each one includes a slotted headrest, two arm boards, four hip/knee pads and a special abdominal pad that allows for chest and diaphragm expansion. But BackPacks are a lot more than that. What makes them truly groundbreaking is the DermaProx covering, a proprietary layer of protection that maximizes skin protection. It’s open cell and breathable, specially designed to prevent shear and wick away moisture.
DermaProx is far superior to the foam products we used before. Unlike traditional table covers, DermaProx helps prevent tear and shear. Unlike foam pads, DermaProx removes moisture, preserving skin pH and preventing irritation and breakdown. Unfortunately, areas where pressure is present will always exist in prone positioning, but patient pressure injuries are dramatically less common thanks in large part to BackPacks.
BackPacks are not only great for the safety of our patients. They are financially beneficial. The price is competitive, but more importantly it saves us on the back end. The average cost of caring for a Stage III or IV pressure ulcer is $43,180, and CMS no longer pays for that. Preventing even one ulcer makes it all worthwhile. As a bonus, because Backpacks contain everything we need in one vacuum-packed bag, it saves us a minimum of 5 minutes every case, and frequently more, increasing staff satisfaction.
Every day, in surgery facilities everywhere, patients sustain pressure injuries. We can do better. Our experience proves that. If you do prone positioning and you have pressure injuries, I encourage you to consider the Xodus Medical Surgical BackPack
. Your patients will thank you.