The Pelosi cesarean delivery technique

Cesarean delivery is the most prevalent major surgical procedure in the United States. The traditional Pfannenstiel technique has long been the standard approach due to its cosmetic benefits and reduced postoperative complications compared to the vertical incisions. However, its reliance on extensive dissection and traditions, rather than robust scientific evidence, has prompted exploration of minimally invasive alternatives. The Pelosi simplified cesarean technique, introduced in 1994, and the Mobius Elastic Abdominal Retractor, developed by the authors in the early 2000s, represented substantial advancements in cesarean delivery, aiming to enhance surgical efficiency, reduce complications, and improve patient recovery. This technique employs limited subcutaneous and rectus fascia division, blunt midline rectus muscles separation, and digital peritoneal entry; eliminates the bladder flap; utilizes a vertical hysterotomy expansion instead of the traditional transverse hysterotomy; eliminates peritoneal closure; and employs in situ 1 single-layer hysterotomy closure. The OB/Mobius Elastic Abdominal Retractor, a flexible self-retaining device, enhances exposure through atraumatic 360-degrees retraction. This presentation reviews the procedural steps of the procedure. The Pelosi simplified cesarean technique and the OB/Mobius retractor mark a strategic shift in cesarean delivery, addressing limitations of the traditional Pfannenstiel method. By minimizing dissection, eliminating unnecessary steps, and optimizing surgical exposure, these innovations were found to reduce operative time, complications, and costs while improving recovery in clinical studies.