Hybrid approach of retractor-based and conventional laparoscopy enabling minimally invasive hysterectomy in a morbidly obese patient: Case report and review of the literature

Abstract

Minimally invasive hysterectomy in obese patients may be limited by laparoscopic sight on the one hand and by intraoperative complications related to reduced ventilation due to pneumoperitoneum on the other. Retractor-based laparoscopy offers an operative technique reducing anesthesia risks. We report the case of laparoscopic hysterectomy in an obese patient of short stature. Laparoscopic supracervical hysterectomy was performed by a hybrid approach of a retractor system exerting its effects on lifting the abdominal wall through gravity and conventional laparoscopy, thus bypassing the adverse effects of pneumoperitoneum on ventilation.

The Management of Gynecological Laparoscopy Complications: Review

“…58 Use of gasless laparoscopy with subcutaneous lifting of the abdominal wall, for example for treatment of ovarian cysts, can reduce the anaesthesia risks associated with insufflation in laparoscopy. 59,60 For example, in a case study of an obese woman of small stature undergoing a laparoscopic hysterectomy, hypercapnia complications arose during insufflation at 14 mm Hg and Trendelenburg position. 60 After consulting with anaesthesia, a hybrid approach involving both gasless retractor-based laparoscopy with additional mild insufflation at 8 mm Hg, to allow moderate pneumoperitoneum and adequate field exposure, was employed.…”

“…59,60 For example, in a case study of an obese woman of small stature undergoing a laparoscopic hysterectomy, hypercapnia complications arose during insufflation at 14 mm Hg and Trendelenburg position. 60 After consulting with anaesthesia, a hybrid approach involving both gasless retractor-based laparoscopy with additional mild insufflation at 8 mm Hg, to allow moderate pneumoperitoneum and adequate field exposure, was employed. These conditions allowed adequate ventilation to be maintained.…”

https://www.emjreviews.com/reproductive-health/article/new-concepts-in-the-therapeutic-management-of-myoma/

“…Some patients are not appropriate for laparoscopy if pneumoperitoneum during laparoscopy is a risk due to adipositas per magna or cardiovascular problems. 35 In perimenopausal patients suffering from bleeding rather than bulky symptoms, the indication for hysterectomy must be established with care. On the one hand, other pathologies (e.g.…”