An effective surgical approach to treat obese patients with gynecological disease using a subcutaneous abdominal wall-retraction device to perform low-pressure laparoscopy: A prospective, single-center study

Abstract

Objective

Laparoscopic surgery of obese patients still represents a real challenge in clinical practice. High-pressure pneumoperitoneum and steep Trendelenburg position are the main anesthesiologic indications to laparotomic conversion. The aim of this prospective study was to assess effectiveness and safety of low-pressure laparoscopic (LPL) procedures using a subcutaneous abdominal wall-retraction (LaparoTenser ®).

Materials and Methods

We enrolled obese patients (BMI ≥ 30 kg/m²) with early-stage endometrial cancer, atypical endometrial hyperplasia and suspicious adnexal mass who were planned for laparoscopic surgery.

Results

A total of 33 patients were included in this study. The median age was 69 (range: 40–83), with a median BMI of 39 kg/m² (range: 33–48). At final pathologic report, 24 patients had endometrial cancer, 4 atypical endometrial hyperplasia, 2 had ovarian borderline tumors and 3 benign cysts. All LPL procedures were performed using the LaparoTenser ® device. Total hysterectomy plus bilateral salpingo-oophorectomy and sentinel node biopsy was the main procedure (69.7 % of cases). Laparotomy conversion rate due to inadequate visualization of the surgical field was 6.1 %. Postoperatively, no patient reported relevant abdominal discomfort caused by lifting of the abdominal wall. Grade < 2 early complications rate was 21.1 %. One grade ≥ 3 complications was reported.

Conclusions

LPL technique using the LaparoTenser ® device is feasible and safe in morbidly obese patients. The wall-lifting device enables adequate viscera exposure creating a large intra-abdominal operative space avoiding the disadvantages of intraperitoneal high-pressure and CO₂ absorption.