Laparoscopic Approach to Retroperitoneal Dissection in the Morbidly Obese Patient

INTRODUCTION: Obesity is a growing health concern within the United States. Per NIH data, 1 in nearly 11 adults have severe obesity (BMI >40). Morbid obesity contributes significant complexity to surgical intervention, in addition to difficulties regarding anesthesia and perioperative course. In patients where prompt surgical intervention is necessary, it is important to utilize surgical techniques that allow safe guidance and operation. OBJECTIVE: The objective of this case is to demonstrate surgical techniques that allow for safe retroperitoneal dissection in the morbidly obese patient. METHODS: Case presentation. 66-year-old female with intermittent postmenopausal bleeding in the setting of grade 1 endometrioid adenocarcinoma of the uterus. Operating room setting. Patient underwent a scheduled robot-assisted laparoscopic hysterectomy with bilateral salpingo-oophorectomy and lymph node assessment. Past medical history included morbid obesity (BMI: 40), COPD, diabetes, HTN. RESULTS: Surgery was performed without complication. Patient was discharged on hospital day 1, and postoperative course was unremarkable. CONCLUSIONS: Adequate visualization, elevation of appropriate tissue, and proficient understanding of pelvic anatomy can allow for safe operation given the additional surgically complexity of morbidly obese patients.