title: The effect of patient body mass index on surgical difficulty in gynaecological laparoscopy.
abstract: BACKGROUND
  Over the past three decades, rates of overweight and obesity internationally have risen to epidemic proportions. There are currently no published prospective studies examining the effect of obesity on gynaecologic laparoscopy for benign indications within a population with obesity rates comparable to Australian women.
  
  
  OBJECTIVE
  To assess and quantify whether increasing patient body mass index negatively impacted upon the ability to successfully complete planned laparoscopic surgery.
  
  
  METHODS
  From January 2009 until October 2012, 307 women undergoing laparoscopic gynaecological surgery for benign pathology were recruited. Intra-operative variables included the following: ease of identification of anatomical landmarks, entry technique and number of attempts, conversion to laparotomy and any complications encountered. Any post-operative complications were recorded at the six week post-operative review.
  
  
  RESULTS
  94.46% of operations were completed as planned. As BMI increased, the ease of identification of important anatomical landmarks significantly decreased. There was no correlation between increasing BMI and surgical complication rates.
  
  
  CONCLUSIONS
  Planned gynaecological laparoscopy can be performed in obese patients with a high likelihood of completion. In this study, obesity was not associated with a significant increase in complication rates or failure to complete the surgery as planned.
authors.affiliation: Department of Endosurgery, Mercy Hospital for Women, Heidelberg, Victoria, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: McIlwaine
authors.forename: Janine
authors.initials: J
authors.lastname: Manwaring
authors.forename: Lenore
authors.initials: L
authors.lastname: Ellett
authors.forename: Melissa
authors.initials: M
authors.lastname: Cameron
authors.forename: Emma
authors.initials: E
authors.lastname: Readman
authors.forename: Rocio
authors.initials: R
authors.lastname: Villegas
authors.forename: Peter
authors.initials: P
authors.lastname: Maher
mesh_terms: D000328:Adult; D059925:Anatomic Landmarks; D015992:Body Mass Index; D061887:Conversion to Open Surgery; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D056865:Ideal Body Weight; D010535:Laparoscopy / Q000009:adverse effects; D009765:Obesity / Q000150:complications; D011446:Prospective Studies
keywords: body mass index; complications; laparoscopic surgery; obesity; surgical outcomes