Robot-assisted total laparoscopic hysterectomy in obese and morbidly obese women

Robot-assisted total laparoscopic hysterectomy in obese and morbidly obese women

Total laparoscopic hysterectomy (TLH) in obese patients is challenging. We sought to evaluate whether total laparoscopic hysterectomies using the da Vinci robotic system in obese patients, in comparison with non-obese patients, is a reasonable surgical approach. One-hundred consecutive robot-assiste...

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Bibliographic Details
Published in:Journal of robotic surgery Vol. 3; no. 3; pp. 141 - 147
Main Authors: Rebeles, Sonia A., Muntz, Howard G., Wieneke-Broghammer, Carrie, Vason, Emily S., McGonigle, Kathryn F.
Format: Journal Article
Language:English
Published: London Springer-Verlag 01-10-2009
Springer Nature B.V
Subjects:
Blood
Body weight
Endometrial cancer
Medicine
Medicine & Public Health
Minimally Invasive Surgery
Obesity
Original Article
Ovarian cancer
Robotic surgery
Surgery
Surgical outcomes
Urology
Uterus
United States > US
Virginia
Obesity
Laparoscopic-assisted hysterectomy
Obese
Total laparoscopic hysterectomy
Hysterectomy
Robot-assisted surgery
Robotics
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Summary:Total laparoscopic hysterectomy (TLH) in obese patients is challenging. We sought to evaluate whether total laparoscopic hysterectomies using the da Vinci robotic system in obese patients, in comparison with non-obese patients, is a reasonable surgical approach. One-hundred consecutive robot-assisted TLHs were performed over a 17-month period. Obesity was not a contraindication to robotic surgery, assuming adequate respiratory function to tolerate Trendelenburg position and, for cancer cases, a small enough uterus to allow vaginal extraction without morcellation. Data were prospectively collected on patient characteristics, total operative time, hysterectomy time, estimated blood loss, length of stay, and complications. Outcomes with non-obese and obese women were compared. The median age, weight, and BMI of the 100 patients who underwent robot-assisted TLH was 57.6 years (30.0–90.6), 82.1 kg (51.9–159.6), and 30.2 kg/m 2 (19.3–60.2), respectively. Fifty (50%) patients were obese (BMI ≥ 30); 22 patients were morbidly obese (BMI ≥ 40). There was no increase in complications ( p  = 0.56) or blood loss ( p  = 0.44) with increasing BMI. While increased BMI was associated with longer operative times ( p  = 0.05), median time increased by only 36 min when comparing non-obese and morbidly obese patients. Median length of stay was one day for all weight categories ( p  = 0.42). Robot-assisted TLH is feasible and can be safely performed in obese patients. More data are needed to compare robot-assisted TLH with other hysterectomy techniques in obese patients. Nonetheless, our results are encouraging. Robot-assisted total laparoscopic hysterectomy may be the preferred technique for appropriately selected obese patients.
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ISSN:1863-2483
1863-2491
DOI:10.1007/s11701-009-0149-3