March 2005 · Vol. 17, No. 3Laparoscopic surgery in the obese: Safe techniques
Increases in atelectasis, wound infection, and other risks after laparotomy point to laparoscopy as the safer route.
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Fast Track
To prevent wound infection, give 1–2 g of a 1st-or 2nd-generation cephalosporin intravenously 20–30 minutes before anesthesia
If an obese patient can tolerate anesthesia and supine positioning, she is also likely to tolerate pneumoperitoneum and changes in position
Realigning the umbilical axis prior to entry reduces the depth of open dissection and prevents piercing both sides of the panniculus
To reduce the risk of bowel herniation close all port sites 10 mm or larger at the fascial level
Early ambulation eases pain and reduces the risk of deep venous thrombosis, pulmonary complications, and ileus
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James
K.
Robinson
III,
MD;
SRS/AAGL Fellow, Newton Wellesley Hospital,
Newton, Mass Keith
B.
Isaacson,
MDAssociate Professor of Obstetrics and Gynecology Harvard Medical School, Boston, Mass Director, Reproductive Endocrinology, Infertility and Minimally Invasive Surgery Newton Wellesley Hospital,
Newton, Mass
Gynecologic laparoscopy in the obese? What was once the purview of the very talented or the foolhardy may now be the preferred surgical approach.
Obese women who undergo laparoscopy recover faster, with less pain, fewer wound infections, and shorter hospital stays than with laparotomy. Though it is true that obesity increases operative time and the risk for conversion to laparotomy, little evidence supports the theory that a body mass index (BMI) of 30 kg/m2 or higher should exclude laparoscopy.
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