Robotic-assisted surgery for endometrial cancer is safe in morbidly and extremely morbidly obese patients

Impact of Patient Body Mass Index on Post-Operative Recovery from Robotic-Assisted Hysterectomy

“…This pragmatic, prospective study has given an in-depth picture of intra-/postoperative events and patient-subjective recovery following RH in a population of patients with different levels of obesity. The results indicate that despite being a high-risk population there was a low risk of intra-and post-operative complications, in keeping with other case series [18], and the median subjective return to previous activity levels was only 4-6 weeks.…”

“…In Mendivil's study of participants with a median BMI of 47.9 kg/m 2 , the maximum operative time was lower in the RS group as compared to the open surgery or LS groups, 2.67 h versus 3.92 h and 4.42 h, respectively. Our study shows that rising patient BMI appears to be associated with a small increase in RH operative times, in keeping with other case series [18,24], and is an important consideration in this typically anaesthetically high-risk population when the duration of procedure may influence post-operative outcomes [28]. Increasing surgical team experience with high-BMI cases can streamline the surgical work flow, reducing conversion rates and increasing lymphadenectomy rates [25].…”

“…For example, 95% of patients with a BMI > 50 did not have nodal assessment [24]. Sentinel lymph node mapping, however, has been reported to be successful in 85.6% of patients with a BMI 40-49.9 kg/m 2 and 73.9% of BMI > 50 kg/m 2 [18]. Lymphadenectomy can be more challenging with rising BMI, in particular para-aortic node assessment, and may result in patients being incompletely staged, although centralising cases to high-volume centres and increasing familiarity with sentinel node mapping is likely to increase the proportion of patients who undergo complete staging in the future [25].…”

“…The risk of conversion to laparotomy increases with BMI, and studies of RS in patients with BMI > 50 kg/m 2 report higher conversion rates as compared with lower BMI patients, 19.6% versus 8% [29] and 6.5% versus 4.3% [18], although this is lower than with LS [11]. One of the reasons for this is due to increased intolerance of steep Trendelenburg position and insufflation, which are known to impact on cardiac function [30] and increase the likelihood of complete airway closure [31].…”