Combined Patient Handling and Positioning Platforms for Steep Trendelenburg and Beyond
What the category is, why it exists, and the clinical evidence behind it. By David Gomez, CRNA.
In most operating rooms, moving the patient and positioning the patient are still two separate jobs done with two separate sets of equipment. The patient is lifted by draw sheet onto a positioning pad, repositioned by draw sheet when the table moves, and secured by whatever that pad offers. A combined patient handling and positioning platform does both jobs with one device: the same reinforced pad that holds the patient in steep Trendelenburg also carries integrated handles that let staff move patient and pad together without a draw sheet. This page defines that category, explains why it exists, and summarizes the clinical evidence behind it.
What a combined patient handling and positioning platform is
A combined platform is a single surgical positioning surface that meets four requirements at once:
- Eight integrated handles, four per side, built into a reinforced pad, so the patient and pad move as one unit during transfer, boosting, and repositioning, and the load is shared across enough hands that no single caregiver carries an unsafe share. No draw sheet sits between the patient and the surface.
- Full pad-to-skin contact across the back, so friction and stability hold the patient in place through steep head-down tilt without shoulder braces or restraints that load the brachial plexus.
- Standardized arm management for both arms-out (abducted) and arms-tucked (adducted) cases, with the arm supported by an adjustable structure rather than wrapped circumferentially in a sheet.
- Airway-first geometry, with the patient positioned proximal to anesthesia so the airway, IVs, and monitoring remain reachable after the robot is docked or the drapes are up.
Products that meet one or two of these are positioning pads. Products that meet all four are combined handling and positioning platforms. Infinitus Medical Technologies introduced the category with the patented Hadron FPLS foam pad lift system and the Genesis Bi-Wing AAP, which adds bi-wing arm adduction to the same handled platform.
Why handling and positioning were ever separate
Surgical positioning pads were designed to solve one problem: keeping the patient from sliding during Trendelenburg. Patient handling equipment was designed to solve a different problem: protecting staff from lifting injuries. The two fields developed in different departments with different budgets, so the operating room ended up with a positioning pad that assumes the patient arrives already in place, and a draw sheet to get them there.
That gap matters most in robotic and laparoscopic pelvic surgery. The patient is induced near the head of the table where anesthesia can manage the airway, then must be relocated toward the foot for lithotomy, often nine to eleven inches, after they are unconscious and cannot assist. In a conventional workflow that relocation is a dead-weight lift by draw sheet, performed by four to six people, repeated when the table is tilted and the patient migrates.
The clinical case for combining them
Staff injury
Perioperative nursing has among the highest rates of musculoskeletal injury in healthcare, and lateral transfer and repositioning of anesthetized patients are the highest-risk tasks. AORN’s ergonomic tools set a 157 pound patient weight threshold for manual repositioning and a 35 pound force reference per caregiver. A draw sheet is not an assistive device. A handled platform is, but only if it has enough handles.
The number of handles decides how the load divides. With a 12 inch draw sheet, four caregivers perform a full dead-weight lift at roughly 70 to 120 pounds or more of peak force each, and morbidly obese cases routinely draw seven or eight staff. A four-handle pad does not solve this: one caregiver per side still carries the full 200 to 240 pound torso load, so per-person force stays well above the 35 pound reference. An eight-handle platform with four handles per side allows two caregivers per side on the torso, each holding two handles. With a provider at the head and one caregiver at the legs, six people share the load, the lift becomes a partial lift plus slide, and modeled peak force falls to about 30 to 55 pounds per caregiver. That is not fewer staff. It is the right number of staff, each within a range the body can sustain case after case.
Patient migration and nerve injury
Steep Trendelenburg for robotic pelvic procedures places patients 30 to 40 degrees head down for hours. Cephalad migration during that time is the mechanism behind brachial plexus injury from shoulder braces, and behind the undocking and repositioning that interrupts the case. Full pad-to-skin contact on a reinforced surface holds the patient without braces. A university robotic program using the Genesis platform reported zero patient migration and no redocking.
Tucked arms
Arm tucking is standard in robotic and lithotomy cases, and it carries measured risk. In 324,124 anesthetics, tucked arms were associated with 6.16 times greater odds of persistent ulnar neuropathy, with odds rising further with BMI and each added hour of surgery. Hand and forearm compartment syndrome has been reported with draw sheets tucked too tightly around the arm. A bi-wing adduction system supports the arm against a padded structure and adjusts to the patient, instead of loading the arm with a weight-bearing sheet. It also preserves access to IVs, pulse oximetry, and blood pressure monitoring for goal-directed fluid therapy.
Pressure injury and microclimate
Across 35 studies, a 2025 systematic review reported a mean pressure injury incidence of 17.22 percent among surgical patients. Risk compounds with duration, position, and the layers between the patient and the surface. A draw sheet is one of those layers: laboratory testing shows added linen restricts a surface’s ability to remove heat and moisture vapor, so the sheet becomes the place where moisture collects against immobile skin. Removing the draw sheet from the interface is a microclimate intervention as well as a handling intervention. Our article on pressure injuries that start in the operating room covers the evidence in detail.
Time under anesthesia
Positioning time is EHR-trackable, which makes it one of the few safety variables a facility can measure before and after a change. Draw-sheet positioning runs 5 to 25 minutes per case depending on patient weight, with 15 minutes a reasonable mid-range. An eight-handle slide takes about 1 to 3 minutes with a standard team. A high-volume robotic program reported 22 minutes released per case from positioning to dock, a range of 17 to 25 minutes, after adopting the Genesis platform. At a composite OR cost of $74 per minute that is about $1,628 per case, or $308 per case at the most conservative staff-pay floor of $14 per minute, against an incremental product cost of about $50. Those minutes are anesthesia exposure the patient no longer receives and OR capacity the facility gets back, and they do not include the $28,000 to $47,000 cost of a single staff lifting injury. The measurements, their sources, and how to reproduce them in your own EHR are set out on the reported outcomes page.
Where the category applies
| Procedure or need | Platform | What it adds |
|---|---|---|
| Robotic and laparoscopic pelvic surgery, steep Trendelenburg, arms tucked | Genesis Bi-Wing AAP | Eight handles (four per side), bi-wing arm adduction, positioning in about 1 to 3 minutes |
| Trendelenburg and lithotomy with arms out | Hadron FPLS | Eight-handle (four per side) reinforced pad; converts to Genesis with a wing kit |
| Anterior hip with traction | Hadron HDP | Traction to reduce perineal post injury; handled transfer after spinal or epidural |
| High-BMI patients up to 750 lb | Genesis XL and Hadron XL | 27-inch width sized to the patient, mechanical lift compatible |
| Inflation-assisted transfer and Trendelenburg positioning | Pneuma | Patented inflatable version of the Genesis platform for air-assisted transfer and positioning |
| Supine procedures with arm management | Luna SP | Full-length reinforced pressure support with Bi-Wing and Ortho-Wing accessories |
| Head and neck alignment in Trendelenburg | Azul ITPW | Inertial wedge that holds alignment while pad-to-skin contact stays at 100 percent |
| Face protection during robotic docking | VisiWrap | Transparent shield for the face and airway |
| Retraction around an adducted arm in high-BMI patients | Kyber SSC | Curved retractor post offset from the arm and torso |
How to evaluate a combined platform
Value analysis committees compare positioning products on unit price. The questions that predict outcomes are different:
- Does the patient move with the pad, or on it? If staff still lift by sheet, handling has not changed.
- How many handles, and where? Four handles put the whole torso on one caregiver per side. Eight handles, four per side, let two caregivers share each side and bring per-person force toward the 35 pound reference.
- What holds the patient in steep Trendelenburg? Friction on a reinforced surface, or braces and straps that load the shoulder?
- How is the tucked arm supported, and can anesthesia still reach the IV and the cuff after docking?
- Where is the patient relative to anesthesia after positioning? Can the airway be managed without undocking?
- What is the positioning time, who measured it, and can your facility reproduce the measurement in its own EHR?
- What is the pad made of, how does it respond to warming, and what is the moisture vapor transmission rate of the surface that touches skin?
- What training and on-site support comes with the trial and the conversion?
Our category value analysis guide works through each of these with the supporting evidence, and the clinical resources library has instructions for use and positioning demonstrations for every platform.
To run the numbers on your own case volume, OR minute rate, and EHR-measured positioning times, download the Genesis cost-of-ownership calculator (Excel). It models disposable kit against disposable Genesis, values released time at your average OR cost per minute, and reports staff time separately.
Frequently asked questions
What is the difference between a positioning pad and a patient handling and positioning platform?
A positioning pad holds the patient in place once they are on it. A combined platform also moves the patient: integrated handles let staff transfer, boost, and reposition patient and pad together without a draw sheet, while full pad-to-skin contact holds the patient through steep Trendelenburg.
Does a handled pad replace the draw sheet entirely?
Yes, for transfer, boosting, and repositioning. No sheet sits between the patient and the pad, which removes both the manual lift and the moisture-trapping layer against the skin.
How many staff does positioning take?
Six, used correctly: a provider at the head managing the airway, two caregivers per side each holding two of the eight handles, and one at the legs. That is the configuration that keeps each caregiver’s share of a 400 pound patient near 30 to 55 pounds. A draw sheet or four-handle pad may use four people, but each of them carries far more, and heavy cases pull in seven or eight staff anyway. The eight-handle slide takes about 1 to 3 minutes.
Why do eight handles matter more than four?
With four handles there is one caregiver per side, and the 200 to 240 pound torso load lands on that person. With eight handles, four per side, two caregivers share each side, so the same load divides across twice the hands and the lift becomes a partial lift plus slide instead of a dead-weight lift.
Are the platforms compatible with mechanical lifts?
Yes. The Genesis Lift and Hadron Lift versions attach to mechanical lifts through a dual bar system, and the XL versions support patients up to 750 pounds when paired with bariatric extenders or the Prometheus platform.
Can the platform be used for lithotomy and robotic docking?
That is the primary use. The patient is positioned proximal to anesthesia, moved to the lithotomy position by handle after induction, and held through steep Trendelenburg without migration or redocking.
Is the platform available on government contract?
Yes. Infinitus Medical Technologies is a certified veteran-owned small business registered in SAM, and federal facilities can purchase directly, including by government purchase card. The platforms are already in use at multiple VA Medical Centers.
Where does the outcome data come from?
From facilities that measured their own operating rooms before and after adoption: a robotic surgery epicenter in Texas for dock time, a university program in Kansas for migration and redocking, and a perioperative team for setup time. Each result, its method, and the EHR intervals to reproduce it are on the reported outcomes page. Reference contacts are available to evaluating facilities through your IMT representative.
How do I arrange a trial?
Request a trial through the Connect page. The IMT clinical team provides on-site education before the trial begins, supports the first cases in person, and trains super users for the conversion.
Sources
- Kurian et al. The Incidence of Pressure Ulcers in Surgical Patients: A Systematic Review. International Wound Journal, 2025.
- Pulos et al. Perioperative Ulnar Neuropathy: A Contemporary Estimate of Incidence and Risk Factors. Anesthesia and Analgesia, 2021.
- AORN. Guideline updates to decrease patient and personnel injuries; safe patient handling and movement ergonomic tools.
- Hand Compartment Syndrome After Prolonged Robotic-Assisted Laparoscopic Rectal Resection: A Case Report and Literature Review, 2024.
- A laboratory study examining the impact of linen use on low air loss support surface heat and water vapor transmission rates, 2013.
- Facility-reported outcomes: robotic dock time reduction and migration data from U.S. robotic surgery programs using the Genesis platform, on file with Infinitus Medical Technologies.
