THE MECHANICS UNDERLYING LAPAROSCOPIC INTRAABDOMINAL SURGERY FOR OBESE PATIENTS

Any surgeon experienced with a laparoscopic approach to intra-abdomina l surgery on morbidly obese patients is aware of the increased difficu lty associated with the patients' obesity, We present a study of the m echanics of laparoscopic surgery that explains the difficulty subjecti vely experienced in terms of the decreased sensitivity felt by the sur geon as a result of the increased thickness of the abdominal wall and increasing force required for the repositioning of the tip of the oper ating instrument, We propose that the placement and angling of the tro car in the abdominal wall are of paramount importance in the successfu l and safe completion of laparoscopic procedures in obese patients.