Introduction/Background Treatment of morbidly obese female patients still represents a challenge, due to cardiorespiratory function and hemodynamic changes that occur during minimally invasive surgery because of pneumoperitoneum and steep Trendelenburg position. The main reasons for LPT conversion in obese patients are inadequate viscera exposure due to adiposity and an intolerance of Trendelenburg.

The aim of this prospective study was to assess conversion to laparotomy and perioperative complications after low pressure laparoscopy (LPL) surgery using a new subcutaneous abdominal wall-retraction device called Laparo-Tenser in morbidly obese patients with gynecological pathology.

Methodology 30 consecutive obese patients (BMI > 35 kg/m2) were eligible for the study and enrolled from October 2020 to April 2023. 20 patients had endometrial cancer, 4 atypical endometrial hyperplasia and 6 BOT/adnexal mass.

Results The mean age was 69, with a mean BMI of 39 kg/m2. The exposure of the operating field was optimal in 28 out 30 cases (93.3%). Laparotomy conversion rate was 6,6% (2/30). One intraoperative complication occurred. An hematoma related to insertion of the subcutaneous needle of the wall lifter occurred. According to the Dindo Classification ≥ a 2, early complications rate was 16%.

Conclusion LPL technique using the LaparoTenser device is safe and feasible in 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 C02 absorption offering greater benefit to obese patients with no effect on the hemodynamic and respiratory functions. LPL technique may assist both surgeon and anesthesiologist to reduce the laparotomic conversions rate. Further studies could confirm our results.

Disclosures The authors have no conflicts of interest to disclose.