Introduction/Background Treatment of morbidly obese gynecological patients still represents a real challenge. Hemodynamic and cardiorespiratory function changes occurring during standard minimally invasive laparoscopic surgery due to high-pressure pneumoperitoneum and steep Trendelenburg position are the main anesthesiological indications to laparotomic conversion. Others are the strictly adiposity related reasons such as inadequate viscera exposure.

The aim of this prospective study was to assess effectiveness and safety of low-pressure laparoscopic (LPL) procedures using a new subcutaneous abdominal wall-retraction device called Laparo-Tenser. Main outcomes were the assessment of conversion rate to laparotomy and perioperative complications rate.

Methodology 33 consecutive obese patients (BMI >35 kg/m2) were eligible for the study and enrolled from October 2020 to June 2023. 24 patients had endometrial cancer, 4 atypical endometrial hyperplasia and 5 had an adnexal mass. Total hysterectomy plus bilateral salpingo-oophorectomy and sentinel node biopsy was the main procedure (69.7% of cases).

Results The mean age was 69, with a mean BMI of 40 kg/m2. The exposure of the operating field was optimal in 26 out 33 cases (78.8%). Laparotomy conversion rate was 21.2% mostly related to specimen extraction (12.1%). Operative time, blood loss, and hospital stay were similar to standard laparoscopy. Postoperatively, no patient reported substantial abdominal discomfort caused by lifting of the abdominal wall. One related Laparo-Tenser complication occurred (a hematoma related to subcutaneous needle insertion, solved spontaneously). According to the Dindo-Classification ≥ 3 no complications occurred, while Grade 2 early complications rate was 12.1%.

Conclusion LPL technique using the Laparo-Tenser device is safe and feasible in morbidly obese female 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. LPL technique may assist both surgeon and anesthesiologist to reduce the laparotomic conversion rate without prolonging the operative time. Further studies could confirm our results.

Disclosures The authors have no conflicts of interest to disclose.