In preparing for a right total nephrectomy, how should the patient be positioned?

For a right total nephrectomy, the ideal position for the patient is the left lateral position. This positioning allows optimal access to the right kidney while minimizing the risk of complications.

When the patient is placed in the left lateral position, the right side of the body is elevated, providing better visualization of the right flank during the surgical procedure. This positioning facilitates the access required to remove the right kidney, particularly from the posterior approach. Additionally, it helps in reducing pressure on the abdominal organs and can enhance ventilation, which is beneficial for maintaining patient stability during surgery.

Other positions, such as supine, prone, or sitting, do not provide the same level of exposure and access to the right kidney. The supine position, while commonly used in various surgeries, would make it more difficult for the surgeon to reach the right nephron effectively. The prone position is typically used for procedures that require access to the posterior aspects of the body, such as certain spinal surgeries, and is not suitable for a nephrectomy. Lastly, the sitting position is not appropriate for this type of surgery as it does not allow the necessary access and can pose risks related to hemodynamics and venous return.