Introduction Treatment of obese female patients represents a challenge, due to cardiac function and hemodynamic changes during minimally invasive surgery with pneumoperitoneum and steep Trendelenburg position. Main reasons for LPT conversion in obese patients were inadequate exposure due visceral adiposity and an intolerance of Trendelenburg. The aim of this prospective study was to assess conversion to laparotomy and perioperative complications after of low pressure laparoscopy (LPL) surgery using a new subcutaneous abdominal wall-retraction device in morbidly obese patients.

Methods 30 consecutive obese patients (BMI > 35 kg/m²) were eligible for the study. 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/Implications LPL technique using the LaparoTenser device is safe and feasible in obese patients. The subcutaneous retractor is a way to create a large intra-abdominal operative space without the need of intraperitoneal high pressure and offers greater benefit to obese patients with no effect on the hemodynamic and respiratory functions. LPL technique may assist both surgeon and anesthesiologist to reduce conversions rate. Prospective studies could confirm our results.