How to facilitate laparoscopy in obese oncologic patients-10 steps towards successful surgery

Objective The prevalence of obesity among patients has increased rapidly, and, according to data from World Health Organization, over 600 million adults are classified as obese (Burgess et al.) [1]. Obesity has clear association with endometrial cancer, which is the most common gynecological malignancy in Western World, but affects also women with other gynecological cancers. Laparoscopy in obese patients is a challenge, but it brings several benefits to this population, therefore, it should be the targeted technique. Methods This video presents in 10 steps several cost-effective strategies that cover the pre-operative work-up, the entire surgical procedure and the patient's recovery. All images have been acquired during oncologic procedures and expose the practical maneuvers undertaken by experienced gynecologic laparoscopic surgeons. Results Ten important steps that facilitate the laparoscopic surgery in the obese population were presented and standardized (Kondo et al.; Scheib et al.; Matsuzaki et al.) [2-4]. These include: 1. Preoperative assessment of the adipose tissue distribution and clinical preparation 2. Patient positioning 3. Curarization 4. Creation of the pneumoperitoneum 5. First trocar placement 6. Trendelenburg position 7. Auxiliary trocars placement 8. Exposure techniques 9. Closure of incisions 10. Postoperative fast track Conclusions The minimally invasive approach in oncologic procedures is a challenge, but when it concerns obese patients, it might be extremely difficult. Due to high prevalence and association of obesity and gynecological malignancies which require invasive treatment, there exists a need for a standardization of surgical approach that brings benefits to this group of patients and which lead to a reduction of human errors and complications.