Types of Surgeries Performed in the Lateral Position
The lateral surgical position, where the patient lies on their side with dependent limbs supported, is widely used across multiple surgical specialties and types of surgeries. This position offers enhanced access to and visualization of lateral anatomical structures and the ability to leverage gravity for tissue retraction. It is especially valuable when the posterior or lateral aspects of the body need exposure. For anesthesiologists and perioperative teams, understanding which procedures use the lateral position helps anticipate physiologic considerations, airway challenges, and pressure-point protection strategies. For patients, understanding the clinical reasoning behind what they experience in the OR enhances their autonomy and can reduce the anxiety of a stressful situation.
Many types of orthopedic surgeries rely on the lateral position for optimal joint access and alignment. Hip procedures such as total hip arthroplasty, hip resurfacing, and open reduction–internal fixation of acetabular or femoral fractures frequently use this approach. Importantly, the lateral position improves exposure to the hip joint while allowing precise manipulation of the femur and acetabulum.
Shoulder surgeries may also use a variant called the lateral decubitus position, particularly in arthroscopic procedures. This setup offers the surgeon a clear view of the glenohumeral joint while enabling traction and improved visualization during rotator cuff repair, labral repairs, and debridement 1–4.
The lateral position is fundamental in thoracic surgery as well. Video-assisted thoracoscopic surgery, open thoracotomies, lung resections, pleural biopsies, and esophageal surgeries often require the patient to be placed on their side. This position allows for lung isolation so that the nondependent lung can be collapsed to provide a clear operating field. The dependent lung receives most of the perfusion, so anesthesiologists must anticipate ventilation–perfusion mismatches and closely monitor oxygenation during one-lung ventilation 5–9.
Some types of spine surgeries may also benefit from lateral positioning. Lateral lumbar interbody fusion and direct lateral interbody fusion enable approaches to the lumbar spine through the psoas muscle, minimizing disruption of posterior spinal structures. These minimally invasive techniques reduce recovery time and preserve surrounding musculature.
Some posterior fossa surgeries or intracranial procedures may use the lateral position to improve access to specific cranial regions and reduce venous congestion 10–14.
The lateral position is also common in surgeries involving the kidneys, ureters, and adrenal glands. Nephrectomy, partial nephrectomy, ureterolithotomy, and adrenalectomy often rely on lateral placement for optimal organ exposure while enabling mobilization of the retroperitoneal space. Both open and laparoscopic renal surgeries use this position, with supports and padding applied carefully to protect the dependent flank 15–17.
Although less common, certain types of colorectal and general surgical procedures use the lateral position for specific access needs. For example, transanal procedures, select rectal surgeries, and perianal operations may use modified lateral positions to optimize visualization and ergonomics. Additionally, lateral positioning helps when drainage or targeted access to one flank is needed 18–22.
The lateral position plays a crucial role in modern surgical practice, supporting procedures across orthopedics, thoracic surgery, neurosurgery, urology, and select general surgical fields. Each specialty leverages the unique advantages of side-lying access to improve visualization, minimize tissue disruption, and enhance safety.
References
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