Connect the Dots—August 2020

The power of studying questions about day-to-day procedures, treatments, and medical decision making never fails to impress me. We try to practice based on the best evidence as it applies to our patient, but sometimes the evidence for what seems like simple things is lacking. An example of a well-designed and reported randomized trial addressing an everyday surgical decision is provided by Gupta et al (see page 333).1 This group analyzed patientreported physical function by a validated questionnaire 6 weeks postoperatively in women who underwent gynecologic surgery in the lithotomy position. After completing baseline questionnaires, women were randomized to positioning in either candy cane (strap) or boot stirrups, and then repeat assessments of physical functioning were obtained at 6 weeks. Women in the boot stirrups reported improved physical functioning, compared with a decline in physical function in the candy cane group. Surgical positioning to allow for adequate visualization and access to the operative field is a fundamental skill. Although this study did not address surgeons’ satisfaction with the positioning, it does address a fundamental patient outcome. It seems that if adequate surgical exposure can be obtained in boot stirrups, the results of this study suggest strong consideration for their use. Nancy C.