The effect of patient body mass index on surgical difficulty in gynaecological laparoscopy

The objective of this pilot study was to evaluate the extent to which laparoscopic gynaecological surgery could be completed as planned in overweight and obese patients versus patients of normal weight. A prospective surgical audit was conducted of 64 women undergoing laparoscopy for benign gynaecological conditions. Patients were grouped according to their body mass index (BMI). The number of attempts required for successful laparoscopic entry, the ability to identify key surgical landmarks, the ability to complete the planned surgery, the rate of conversion to laparotomy and the complication rates were recorded. Surgery was completed as planned in 95.31% of participants. Completion rates declined with increasing BMI. Increased entry attempts and an inability to identify key surgical landmarks were associated with increased BMI, although the sample size was insufficient to provide any statistically significant conclusions. The overall complication rate was 6.25%. There was a higher mean BMI in patients with a complication; however, there was insufficient data to show a significant difference. This study suggests an association between increasing BMI and increased entry attempts for laparoscopy, increased difficulty in surgical landmark identification and an overall reduction in completion of gynaecological laparoscopy as planned.