Laparoscopic surgical access in morbidly obese women undergoing endometrial cancer surgery: Repurposing the left upper quadrant approach

Aaron Varghese*, Elizabeth Peijnenburg, Rebecca L. Stone, Stephanie L. Wethington, Kimberly L. Levinson, Anna Beavis, Ting Tai Yen, Edward J. Tanner, Amanda N. Fader

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Objective: The study purpose was to report the outcomes of patients undergoing endometrial cancer surgical staging with laparoscopic abdominal access entry using a left upper quadrant (LUQ) access technique. Methods: This was a retrospective cohort study conducted from 1 January 2013 to 1 January 2018. The setting was an academic, single institution gynecologic oncology service with a high volume of minimally invasive surgery (MIS). The patient cohort included obese (defined as BMI > 30 kg/m2) or morbidly obese (BMI > 40 kg/m2) women undergoing MIS for endometrial cancer staging. All patients underwent laparoscopic abdominal access via a 5-mm or 10-mm optical trocar system using a LUQ technique. Results: In total, 317 patients were included with a median age of 54 years (range, 24–79) and median BMI 42.5 kg/m2 (range, 32–70); 60 % morbidly obese. Successful LUQ access was achieved in 98.1 %. Of those with a failed LUQ approach, two had undergone previous LUQ surgery and 4 had ≥1 previous midline vertical incisions. There was one LUQ trocar-related visceral injury (0.3 %) and no vascular injuries during the study period. Conclusion: A LUQ abdominal technique is a safe and reliable method of laparoscopic access in morbidly obese women undergoing MIS for endometrial cancer staging. This may be the preferred method of laparoscopic access for women with a panniculus or central adiposity, given the caudal displacement of the umbilicus and poor correlation with intraperitoneal anatomic landmarks in this setting.

Original languageEnglish (US)
Pages (from-to)56-59
Number of pages4
JournalEuropean Journal of Obstetrics and Gynecology and Reproductive Biology
Volume244
DOIs
StatePublished - Jan 2020
Externally publishedYes

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Endometrial Neoplasms
Minimally Invasive Surgical Procedures
Neoplasm Staging
Surgical Instruments
Anatomic Landmarks
Umbilicus
Optical Devices
Vascular System Injuries
Adiposity
Cohort Studies
Retrospective Studies
Wounds and Injuries

Keywords

  • Endometrial neoplasms
  • Laparoscopy
  • Minimally invasive surgical procedures
  • Obesity

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

Cite this

Varghese, Aaron ; Peijnenburg, Elizabeth ; Stone, Rebecca L. ; Wethington, Stephanie L. ; Levinson, Kimberly L. ; Beavis, Anna ; Yen, Ting Tai ; Tanner, Edward J. ; Fader, Amanda N. / Laparoscopic surgical access in morbidly obese women undergoing endometrial cancer surgery : Repurposing the left upper quadrant approach. In: European Journal of Obstetrics and Gynecology and Reproductive Biology. 2020 ; Vol. 244. pp. 56-59.
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abstract = "Objective: The study purpose was to report the outcomes of patients undergoing endometrial cancer surgical staging with laparoscopic abdominal access entry using a left upper quadrant (LUQ) access technique. Methods: This was a retrospective cohort study conducted from 1 January 2013 to 1 January 2018. The setting was an academic, single institution gynecologic oncology service with a high volume of minimally invasive surgery (MIS). The patient cohort included obese (defined as BMI > 30 kg/m2) or morbidly obese (BMI > 40 kg/m2) women undergoing MIS for endometrial cancer staging. All patients underwent laparoscopic abdominal access via a 5-mm or 10-mm optical trocar system using a LUQ technique. Results: In total, 317 patients were included with a median age of 54 years (range, 24–79) and median BMI 42.5 kg/m2 (range, 32–70); 60 {\%} morbidly obese. Successful LUQ access was achieved in 98.1 {\%}. Of those with a failed LUQ approach, two had undergone previous LUQ surgery and 4 had ≥1 previous midline vertical incisions. There was one LUQ trocar-related visceral injury (0.3 {\%}) and no vascular injuries during the study period. Conclusion: A LUQ abdominal technique is a safe and reliable method of laparoscopic access in morbidly obese women undergoing MIS for endometrial cancer staging. This may be the preferred method of laparoscopic access for women with a panniculus or central adiposity, given the caudal displacement of the umbilicus and poor correlation with intraperitoneal anatomic landmarks in this setting.",
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author = "Aaron Varghese and Elizabeth Peijnenburg and Stone, {Rebecca L.} and Wethington, {Stephanie L.} and Levinson, {Kimberly L.} and Anna Beavis and Yen, {Ting Tai} and Tanner, {Edward J.} and Fader, {Amanda N.}",
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Laparoscopic surgical access in morbidly obese women undergoing endometrial cancer surgery : Repurposing the left upper quadrant approach. / Varghese, Aaron; Peijnenburg, Elizabeth; Stone, Rebecca L.; Wethington, Stephanie L.; Levinson, Kimberly L.; Beavis, Anna; Yen, Ting Tai; Tanner, Edward J.; Fader, Amanda N.

In: European Journal of Obstetrics and Gynecology and Reproductive Biology, Vol. 244, 01.2020, p. 56-59.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Laparoscopic surgical access in morbidly obese women undergoing endometrial cancer surgery

T2 - Repurposing the left upper quadrant approach

AU - Varghese, Aaron

AU - Peijnenburg, Elizabeth

AU - Stone, Rebecca L.

AU - Wethington, Stephanie L.

AU - Levinson, Kimberly L.

AU - Beavis, Anna

AU - Yen, Ting Tai

AU - Tanner, Edward J.

AU - Fader, Amanda N.

PY - 2020/1

Y1 - 2020/1

N2 - Objective: The study purpose was to report the outcomes of patients undergoing endometrial cancer surgical staging with laparoscopic abdominal access entry using a left upper quadrant (LUQ) access technique. Methods: This was a retrospective cohort study conducted from 1 January 2013 to 1 January 2018. The setting was an academic, single institution gynecologic oncology service with a high volume of minimally invasive surgery (MIS). The patient cohort included obese (defined as BMI > 30 kg/m2) or morbidly obese (BMI > 40 kg/m2) women undergoing MIS for endometrial cancer staging. All patients underwent laparoscopic abdominal access via a 5-mm or 10-mm optical trocar system using a LUQ technique. Results: In total, 317 patients were included with a median age of 54 years (range, 24–79) and median BMI 42.5 kg/m2 (range, 32–70); 60 % morbidly obese. Successful LUQ access was achieved in 98.1 %. Of those with a failed LUQ approach, two had undergone previous LUQ surgery and 4 had ≥1 previous midline vertical incisions. There was one LUQ trocar-related visceral injury (0.3 %) and no vascular injuries during the study period. Conclusion: A LUQ abdominal technique is a safe and reliable method of laparoscopic access in morbidly obese women undergoing MIS for endometrial cancer staging. This may be the preferred method of laparoscopic access for women with a panniculus or central adiposity, given the caudal displacement of the umbilicus and poor correlation with intraperitoneal anatomic landmarks in this setting.

AB - Objective: The study purpose was to report the outcomes of patients undergoing endometrial cancer surgical staging with laparoscopic abdominal access entry using a left upper quadrant (LUQ) access technique. Methods: This was a retrospective cohort study conducted from 1 January 2013 to 1 January 2018. The setting was an academic, single institution gynecologic oncology service with a high volume of minimally invasive surgery (MIS). The patient cohort included obese (defined as BMI > 30 kg/m2) or morbidly obese (BMI > 40 kg/m2) women undergoing MIS for endometrial cancer staging. All patients underwent laparoscopic abdominal access via a 5-mm or 10-mm optical trocar system using a LUQ technique. Results: In total, 317 patients were included with a median age of 54 years (range, 24–79) and median BMI 42.5 kg/m2 (range, 32–70); 60 % morbidly obese. Successful LUQ access was achieved in 98.1 %. Of those with a failed LUQ approach, two had undergone previous LUQ surgery and 4 had ≥1 previous midline vertical incisions. There was one LUQ trocar-related visceral injury (0.3 %) and no vascular injuries during the study period. Conclusion: A LUQ abdominal technique is a safe and reliable method of laparoscopic access in morbidly obese women undergoing MIS for endometrial cancer staging. This may be the preferred method of laparoscopic access for women with a panniculus or central adiposity, given the caudal displacement of the umbilicus and poor correlation with intraperitoneal anatomic landmarks in this setting.

KW - Endometrial neoplasms

KW - Laparoscopy

KW - Minimally invasive surgical procedures

KW - Obesity

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