Laparoscopic exposure in obese high-risk patients with mechanical displacement of the abdominal wall

Obstet Gynecol. 2004 Feb;103(2):383-6. doi: 10.1097/01.AOG.0000110543.14290.35.

Abstract

Background: Patients with morbid obesity or pulmonary disease are at a higher risk for complications during advanced laparoscopic procedures. Higher intraperitoneal carbon dioxide pressures required to elevate the pannus can negatively impact hemodynamic and respiratory parameters.

Cases: We describe a technique that uses a combination of a mechanical retractor and a Foley catheter inserted midway between the umbilicus and the pubic symphysis that assists in elevating the anterior abdominal wall. In 3 cases this technique allowed for a low-pressure pneumoperitoneum during advanced laparoscopic pelvic surgery, which resulted in improved hemodynamic parameters and pulmonary function in these high-risk patients.

Conclusion: The Foley Lap-Lift facilitated laparoscopy through mechanical abdominal wall elevation and allowed for a lower-pressure pneumoperitoneum. This technique is an addition to traditional operative laparoscopy in select high-risk patients.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Abdominal Wall / physiopathology
  • Abdominal Wall / surgery*
  • Adult
  • Body Mass Index
  • Female
  • Follow-Up Studies
  • Genital Diseases, Female / surgery
  • Gynecologic Surgical Procedures / adverse effects
  • Gynecologic Surgical Procedures / methods
  • Humans
  • Laparoscopes
  • Laparoscopy / adverse effects
  • Laparoscopy / methods*
  • Middle Aged
  • Obesity, Morbid / complications
  • Obesity, Morbid / surgery*
  • Pneumoperitoneum, Artificial
  • Postoperative Complications / prevention & control
  • Risk Assessment
  • Sampling Studies
  • Treatment Outcome