Videolaparoscopic cholecystectomy in the obese patient

: The difficulties which arise when performing VLC in obese patients primarily concern the induction of pneumoperitoneum and the use of normal surgical instruments. This is due to the thickness of the abdominal wall and the scarce anchorage of the cutis and subcutis to the musculo-fascia level. Two technical variations of pneumoperitoneum are proposed in order to overcome the first problem, whereas with regard to the latter the authors suggest moving the trocar insertion points towards the site of the gallbladder.