Techniques – Speculum-assisted approach for efficient open laparoscopic port access in the morbidly obese

Transperitoneal laparoscopic and robotic minimally invasive techniques for the management of renal cell carcinoma (RCC) are widely used. Despite familiarity with entry techniques, intraoperative adverse events attributed to the initial entry into the abdomen do occur. Open-entry methods (Hasson technique) remain commonly used in community and academic settings owing to the confidence of avoiding and recognizing major adverse events.1 Obesity, defined as a body mass index (BMI) of greater than 30 kg/m2, provides a technical challenge to gaining efficient open entry. Laparoscopic nephrectomy has been shown to be safe in obese populations, with an acceptable complication profile but longer operative times.2 It is not uncommon at our centre to operate on patients with a BMI of 40 kg/m2 or greater. We describe the use of a traditional vaginal speculum that can be done by a single operator to aid in gaining efficient initial open access in an obese patient