Four-Point Support Frame Positioning for Obese Patients Undergoing Minimally Invasive Esophagectomy. A Preliminary Institutional Experience.

Prone minimally invasive esophagectomy offers several technical advantages; however, in obese patients, increased abdominal pressure may contribute to diaphragmatic elevation, leading to difficulty in first-port placement and compromised operability in the lower mediastinum. These technical challenges can be particularly relevant in robot-assisted procedures, where adequate working space and sufficient inter-arm distance are required. We describe a positioning modification using a 4-point support frame in obese patients undergoing prone minimally invasive esophagectomy. By supporting the thorax and pelvis while allowing the abdomen to hang freely, this strategy is intended to reduce abdominal compression and prevent diaphragmatic elevation. In our preliminary institutional experience, this approach facilitated port placement in the standard configuration and provided stable lower mediastinal exposure. Although based on a limited series, this positioning technique may represent a practical and reproducible option for selected obese patients undergoing prone minimally invasive esophagectomy.