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Obstetrics & Gynecology 2004;103:383-386
© 2004 by The American College of Obstetricians and Gynecologists
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CASE REPORT

Laparoscopic Exposure in Obese High-Risk Patients With Mechanical Displacement of the Abdominal Wall

Michael P. Stany, MD, William E. Winter, III, MD, Louis Dainty, MD, Ernest Lockrow, DO and Jay W. Carlson, DO

Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC

Address reprint requests to: Jay W. Carlson, DO, Department of Obstetrics and Gynecology, Room 2J06, Building 2, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Washington, DC 20307; e-mail: jay.carlson{at}na.amedd.army.mil.

ABSTRACT

BACKGROUND: Patients with morbid obesity or pulmonary diseaseareatahigherriskforcomplicationsduringadvanced laparoscopic procedures. Higher intraperitoneal carbon dioxide pressures required to elevate the pannus can negatively impact hemodynamic and respiratory parameters.

CASES: We describe a technique that uses a combination of a mechanical retractor and a Foley catheter inserted midway between the umbilicus and the pubic symphysis that assists in elevating the anterior abdominal wall. In 3 cases this technique allowed for a low-pressure pneumoperitoneum during advanced laparoscopic pelvic surgery, which resulted in improved hemodynamic parameters and pulmonary function in these high-risk patients.

CONCLUSION: The Foley Lap-Lift facilitated laparoscopy through mechanical abdominal wall elevation and allowed for a lower-pressure pneumoperitoneum. This technique is an addition to traditional operative laparoscopy in select high-risk patients.






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