Understanding: What is the left lateral position used for in surgery?

September 25, 2025 •

4 min read

Patient positioning is a cornerstone of surgical success and safety, with each posture designed for specific procedural and physiological needs. Knowing what is the left lateral position used for in surgery is vital, as it provides optimal access for procedures involving the right side of the body while ensuring patient comfort and minimizing complications.

Quick Summary

The left lateral position is used in surgery to provide the medical team with access to the right side of a patient's body for procedures on the thorax, kidneys, hips, and spine. This position maximizes surgical visibility and maneuverability while prioritizing patient safety and physiological alignment.

Key Points

Right Side Access: The primary purpose of the left lateral position is to expose the right side of the patient's body for procedures on the chest, abdomen, or extremities.
Surgical Applications: This position is used for a variety of procedures, including kidney surgery, thoracic surgery, certain orthopedic hip and shoulder surgeries, and spine access.
Essential Padding: To prevent nerve damage and pressure sores, meticulous padding is required for bony prominences like the ears, shoulders, hips, and ankles on the dependent side.
Brachial Plexus Protection: An axillary roll is placed under the dependent chest wall, not in the axilla, to protect the delicate brachial plexus from compression.
Enhanced Airway Management: For unconscious patients, this side-lying position can promote effective drainage from the mouth, reducing the risk of aspiration.
Dependent Leg Flexion: For stability, the dependent leg is bent at the hip and knee, with a pillow placed between the legs.
Minimizing Risks: Careful monitoring and using specialized equipment are crucial to mitigate risks of nerve damage, pressure injuries, and cardiovascular changes associated with the position.

The Purpose of the Left Lateral Position

Patient positioning is a critical aspect of perioperative care, ensuring the surgeon has optimal access to the operative site while protecting the patient from injury. In the left lateral position, the patient is placed on their left side with the right side of their body facing upward. This provides superior exposure for procedures where the surgical site is on the right side of the torso or extremities.

Providing Access to Specific Body Regions

This orientation is instrumental for a variety of surgical disciplines. By placing the patient on their non-operative side, the surgical team can approach the target anatomy without obstruction from surrounding structures. The primary applications include procedures on the:

Thorax: Surgeries on the right lung or other structures within the right side of the chest cavity, such as a thoracotomy.
Kidney and Retroperitoneal Space: Operations on the right kidney, adrenal gland, or other organs located behind the abdominal lining. The lateral kidney position, a variation with a table flexion, is often used for this purpose.
Hip and Shoulder: Certain orthopedic procedures, such as shoulder arthroscopy or hip replacement, may be performed in this position to facilitate access to the joint.
Spine: Procedures addressing the lumbar spine, specifically for lateral access techniques, such as LLIF, are often performed with the patient in the lateral position.
Ear, Nose, and Throat (ENT): Operations on the ear or other lateral head and neck structures may require this positioning.
Colorectal: Some colorectal procedures can be performed in a lateral position, with a Sims' position variation offering excellent access to the rectal area.

Proper Setup and Patient Safety in Left Lateral Position

Executing the left lateral position correctly is a complex process that involves careful coordination by the perioperative team to prevent injury. A meticulous setup includes several critical steps:

Initial Assessment: Before positioning, a full patient risk assessment is performed, considering the patient's age, weight, and any pre-existing conditions.
Turning the Patient: The patient is typically anesthetized in the supine position and then turned onto their left side by a trained team of at least four people.
Head and Neck Alignment: A pillow or specialized head positioner is used to keep the head aligned with the spine, protecting the dependent ear and preventing cervical nerve damage.
Axillary Support: An axillary roll is placed under the dependent thorax, distal to the axillary crease, to relieve pressure on the neurovascular structures of the axilla and prevent brachial plexus compression.
Arm Positioning: The arms are placed on parallel, padded arm boards. The dependent arm is slightly flexed, and the non-dependent arm is supported with pillows. Abduction should be limited to less than 90 degrees to protect nerves.
Leg and Pelvic Support: The dependent leg is flexed at the hip and knee for stability. A pillow is placed between the legs to protect the bony prominences of the knees and ankles. Safety straps are secured across the hips and sometimes the knees.
Padding Bony Prominences: All bony areas in contact with the table, including the ear, shoulder, hips, knees, and ankles, are padded meticulously to prevent pressure sores.

Comparison of Lateral and Related Surgical Positions


Feature	Left Lateral Position	Right Lateral Position	Sims' Position
Patient Orientation	Lies on left side; right side is operative side.	Lies on right side; left side is operative side.	Lies on left side; right leg and hip are flexed toward chest.
Common Uses	Right thorax, right kidney, right hip, spine access.	Left thorax, left kidney, left hip, spine access.	Rectal exams, enemas, some vaginal procedures.
Key Benefit	Optimizes access to a specific side of the body, improves ventilation.	Optimizes access to a specific side of the body, improves ventilation.	Improved access to the rectal area, especially for conscious patients.
Key Risks	Brachial plexus injury, pressure sores on dependent side.	Brachial plexus injury, pressure sores on dependent side.	Pressure injuries on dependent side, potential patient discomfort.

The Benefits of Using the Left Lateral Position

Beyond simple surgical access, this position offers several physiological benefits that contribute to patient safety and surgical outcomes. For instance, in patients with severe respiratory failure or unilateral pneumonia, positioning the patient on their healthy lung can improve ventilation and perfusion. For unconscious patients, the lateral position can help promote airway patency and drainage, reducing the risk of aspiration. Furthermore, for obese patients, this position can help displace the abdominal panniculus, improving visualization of the flank and retroperitoneal space.

Potential Risks and Mitigation Strategies

Despite its advantages, the left lateral position carries risks that must be managed diligently. The most common complications are related to pressure on nerves and bony prominences on the dependent side of the body.

Nerve Damage: The brachial plexus in the axilla and the peroneal nerve at the knee are particularly vulnerable to compression. This is mitigated by using an axillary roll and padding bony areas.
Pressure Injuries: Prolonged pressure can cause ischemia and lead to skin breakdown, particularly on the ear, shoulder, hip, and ankle. Careful, regular monitoring and adequate padding are essential to prevent this.
Cardiovascular and Respiratory Compromise: The position can lead to a ventilation-perfusion mismatch, and venous pooling can occur in the lower extremities. Anesthesia providers monitor these changes and adjust support as necessary.

For a detailed overview of patient positioning best practices, the StatPearls article on anatomy and patient positioning from the NCBI Bookshelf is an excellent resource: Anatomy, Patient Positioning - StatPearls - NCBI Bookshelf.

Conclusion

The left lateral position is a highly specific and effective tool in the operating room, chosen for its ability to provide surgeons with clear, unobstructed access to the right side of the patient's body for a variety of complex procedures. Its use is a testament to the meticulous planning involved in modern surgery, balancing the need for optimal surgical conditions with the paramount importance of patient safety. Proper execution, including rigorous padding and alignment, is key to mitigating the associated risks and ensuring successful outcomes.

Frequently Asked Questions

While both are lateral positions, the Sims' position is a specific variation of the left lateral position where the patient's right leg is flexed toward the chest, providing specialized access for rectal or vaginal examinations and procedures.

The brachial plexus is at risk of injury due to compression in the axilla (armpit) on the dependent side. This is mitigated by placing an axillary roll or pad under the chest wall, away from the armpit, to redistribute pressure.

Yes, lying on one side can cause a ventilation-perfusion mismatch, where the weight of the chest on the dependent lung can alter breathing patterns. Anesthesia providers monitor these changes closely throughout the procedure.

Yes, specialized tables, bean bag positioners, arm boards, and rolls are used to provide safe, stable, and comfortable positioning. Variations like the lateral kidney position often use a table that flexes at the patient's iliac crest.

The most common risks include nerve damage (especially the brachial plexus and peroneal nerve), pressure injuries or sores on bony prominences, and potential cardiovascular compromise due to venous pooling.

Stability is achieved by flexing the dependent leg at the hip and knee, placing pillows between the legs, and securing the patient with safety straps across the hips and legs. This prevents the patient from rolling during surgery.

Yes, the lateral position is sometimes used during labor and delivery to provide comfort for the mother between pushes and to help reduce the risk of perineal tears. It is also used to relieve pressure on the vena cava.