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


METHODS
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.


CONCLUSIONS
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.
Stany
Michael P
MP
Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Washington, DC 20307, USA.
Winter
William E
WE
Dainty
Louis
L
Lockrow
Ernest
E
Carlson
Jay W
JW
D034861:Abdominal Wall / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D005831:Genital Diseases, Female / Q000601:surgery; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011028:Pneumoperitoneum, Artificial; D011183:Postoperative Complications / Q000517:prevention & control; D018570:Risk Assessment; D012494:Sampling Studies; D016896:Treatment Outcome