The mechanics underlying laparoscopic intra-abdominal surgery for obese patients.

Any surgeon experienced with a laparoscopic approach to intra-abdominal surgery on morbidly obese patients is aware of the increased difficulty associated with the patients' obesity. We present a study of the mechanics of laparoscopic surgery that explains the difficulty subjectively experienced in terms of the decreased sensitivity felt by the surgeon as a result of the increased thickness of the abdominal wall and increasing force required for the repositioning of the tip of the operating instrument. We propose that the placement and angling of the trocar in the abdominal wall are of paramount importance in the successful and safe completion of laparoscopic procedures in obese patients.