A surgical positioning system includes a flexible air-impermeable shell filled with beads that is wrapped against the patient and subjected to a vacuum to hold the patient in place. The shell includes rounded shoulder portions, on either side of a separately inflatable pillow, to envelop portions of the patients neck and shoulders, tapered waist portion to provide easy access to a patients forearms and lower lateral abdomen, and expanded wrist hand portion to cradle the patients hands and thighs.