The lithotomy position is a common surgical posture where you lie on your back with your legs raised, bent at the knees, and supported in stirrups. Your hips are typically flexed to about 90 degrees and spread apart at roughly 30 degrees, with knees bent between 70 and 90 degrees. It’s one of the most frequently used positions in operating rooms and exam rooms, giving doctors clear access to the pelvic and perineal area.
Why It’s Called “Lithotomy”
The name comes from Greek: “lithos” meaning stone and “tomos” meaning cut. It originally referred to a specific surgical procedure for removing bladder stones through a cut in the perineum (the area between the genitals and anus). This operation dates back to at least the first century AD, when the Greek physician Celsus described pushing a bladder stone down to where it could be felt through the skin, then cutting directly onto it. The procedure was so specialized that the Hippocratic oath specifically told physicians to “leave this to those who are trained in this craft.”
Over the centuries, the position outlived the procedure it was named after. Today, bladder stones are rarely removed this way, but the legs-elevated posture became standard for a wide range of surgeries and examinations.
Procedures That Use This Position
You’ll encounter the lithotomy position across several medical specialties. In gynecology, it’s the standard position for pelvic exams, Pap smears, IUD insertions, and many surgeries including hysterectomies. It’s also used during childbirth, though research has shown that upright and side-lying pushing positions are associated with fewer assisted deliveries, shorter second-stage labor, and lower rates of episiotomy compared to lying flat on your back.
Urologists use it for procedures involving the bladder, prostate, and urethra. Colorectal surgeons rely on it for hemorrhoid surgery, rectal repairs, and other operations on the lower bowel. It’s also the go-to position for many laparoscopic and robotic-assisted surgeries in the pelvis.
What It Feels Like for the Patient
If you’re told you’ll be placed in the lithotomy position, here’s what to expect. You’ll start lying flat on an operating or exam table. Padded stirrups or leg supports are attached to the table, and your legs are lifted into them, usually by a nurse or surgical assistant. Your buttocks are positioned right at the edge of the table’s lower break so the surgeon has unobstructed access.
For a brief exam, the position is mildly uncomfortable but manageable. For longer procedures, you’ll be under anesthesia and won’t feel the positioning at all. Surgical teams are trained to protect your privacy during positioning, keeping you draped and limiting exposure to what’s necessary. Perioperative nurses serve as patient advocates during this process, coordinating with the surgeon and anesthesiologist to ensure you’re positioned safely and with dignity.
How It Affects Your Body
Raising your legs above the level of your heart changes how blood flows through your body. Blood from your lower limbs returns to your chest more readily, increasing the volume of blood your heart pumps with each beat. Studies measuring cardiac function have found that stroke volume and cardiac index both increase in the lithotomy position compared to lying flat, even without any medications. In practical terms, this means your heart is working with a slightly larger supply of blood.
For most healthy people, these shifts are minor and well tolerated. They become more relevant for patients with heart conditions, where the sudden increase in blood returning to the heart could pose a challenge. Anesthesiologists monitor these changes closely during surgery.
Nerve Injury Risks
The most common complication from the lithotomy position is nerve compression in the legs. The peroneal nerve, which wraps around the bony bump just below the outer knee, is especially vulnerable. When the leg presses against a stirrup at that spot, the nerve can be squeezed enough to cause temporary damage. This typically shows up as numbness, tingling, or weakness in the foot and lower leg after surgery.
Reported rates of lower extremity nerve problems range from about 0.1% to 6.6%, depending on the type of surgery and how long it takes. Robotic-assisted surgeries tend toward the higher end of that range (0.8% to 6.6%), likely because they often run longer. One study of perineal prostatectomy using an exaggerated version of the position found temporary nerve dysfunction in 21% of patients. Most of these injuries resolve on their own over days to weeks, though recovery can occasionally take months.
Compartment Syndrome
A rarer but more serious risk is well-leg compartment syndrome. When your legs are elevated for extended periods, blood flow to the lower limbs decreases while pressure inside the muscle compartments builds. If the pressure gets high enough, it can damage muscles and nerves permanently.
Time in the position is the biggest risk factor. The American Association of periOperative Registered Nurses set an early guideline recommending no more than 6.5 hours in leg supports, though there’s no universally agreed-upon safe cutoff. Cases have been reported after surgeries as short as 90 minutes, including one involving a young woman undergoing a gynecological procedure. Warning signs include severe calf pain that seems out of proportion to the surgery, swelling, and pain when the foot is flexed. This is a surgical emergency requiring immediate treatment.
How Surgical Teams Reduce Risk
Several practical steps lower the chance of complications. Proper padding on stirrups protects the peroneal nerve at the outer knee. Positioning the legs so that no single point bears excessive pressure helps maintain blood flow. For longer surgeries, some teams will periodically lower the legs briefly to restore circulation, though this depends on the procedure.
Both legs are raised and lowered slowly and simultaneously to avoid sudden shifts in blood pressure. Catheters, drainage tubes, and IV lines are secured before repositioning and checked afterward to make sure nothing has kinked or disconnected. The surgical team also checks that your fingers and toes aren’t caught in any moving parts of the table, a simple but important step that’s part of standard positioning protocols.