What are the challenges of laparoscopy in morbid obese patients?

Abstract

Laparoscopic surgery requires the insufflation of carbon dioxide in the peritoneal cavity under pressure to create sufficient surgical workspace. The physiologic effects of pneumoperitoneum include systemic absorption of CO 2 and physiologic alteration in respiratory and cardiovascular homeostasis due to the increased intraabdominal pressure. Few studies have examined the effects of CO 2 pneumoperitoneum in the morbidly obese. There is frequently insufficient workspace. High insufflation pressures can help but further challenge the respiratory and hemodynamic function. We first looked at how to measure the surgical workspace. We searched for what the laparoscopic surgeons need for workspace. Are there objective measures that the surgical workspace is more limited in obese patients? We ended with questioning the methods available to improve the surgical workspace and to reduce the respiratory and hemodynamic problems in morbidly obese patients.