Operative positioning of morbidly obese patients presents unique challenges and can cause complications, especially when the operative field involves the proximal lower extremity or genitoperineal region. PURPOSE: The purpose of this case study was to describe a modified lithotomy operative positioning technique that has helped the authors improve care of these patients. METHODS: Double-layer, foam padding at least 4 inches thick is secured to the top and sides of 2 small rolling preparation tables using 3-inch silk tape to create “lithotomy” leg holders, the operating table is raised appropriately, the abducted legs are placed onto the padded prep tables, and the footboard is carefully lowered to provide access to the groin and medial thighs. CASE STUDY: A super morbidly obese (body mass index 74), 47-year-old African American man with a history of hypertension and type 2 diabetes controlled on oral medications presented to the authors’ wound care clinic with 2 large, medial left thigh lymphedema masses requiring resection. Both procedures were successfully completed using the modified lithotomy position. No adverse events occurred. CONCLUSION: The modified lithotomy is easy to implement, does not require unique equipment, improves access to the surgical site, and may reduce the risk of complications. Larger and longer-term follow-up studies are needed to monitor the outcomes of this positioning technique.