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

Research output: Contribution to journalArticle


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
StatePublished - Jan 2020



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

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

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