Surgical Technique and Difficult Situations from Rolv-Ole Lindsetmo (Laparoscopic)

The obese patient offers a challenge in laparoscopic surgery in the pelvis, especially in men. However, it is these patients which have the biggest potential benefit from minimal invasive surgery because they suffer more often from wound infections and incision hernias after open surgery. It is therefore our opinion that obesity in itself should not be a contraindication to laparoscopy. In any case, most of the procedure may be done laparoscopically before eventual conversion (like taking down the splenic flexure and mobilisation of the descending colon). In fact, it is actually often easier to find the right plane of dissection under the mesocolon and behind the mesorectal plane in obese patients due to less tenuous texture of the tissues in the correct plane of dissection.