Total laparoscopic hysterectomy as a primary surgical treatment for endometrial cancer in morbidly obese women

Abstract

To evaluate the feasibility of total laparoscopic hysterectomy as the primary treatment for endometrial cancer in morbidly obese women, an audit was carried out during an 18-month period in a tertiary referral centre for gynaecological oncology. Four women who had laparoscopic surgery were compared with a similar cohort who had open surgery. The mean operating time was equivalent, without evidence of excess morbidity with the laparoscopic approach. However, inpatient stay was longer with open versus laparoscopic surgery (11.5 vs 4 days). Laparoscopic surgery is safe to use in morbidly obese women with endometrial cancer.

Comparison of laparoscopic versus conventional open surgical staging procedure for endometrial cancer

“…[3][4][5][6][7][8][9][10][11][12] Disadvantages of the laparoscopic approach include a two-dimensional view, dependence on assistance skill, decreased range of motion and degree of freedom of instruments, and ergonomic limitations to the surgeon. Despite these temporary disadvantages, with the proper training, surgeons are able to adapt to this method of surgery.…”

“…2 Since Childers and Surwit first proposed laparoscopic surgical staging as an alternative for early endometrial cancer, several studies have shown that this approach was an effective and economically efficient alternative to open surgery. [3][4][5][6][7] It is known that the laparoscopic approach is associated with a shorter hospitalization, faster recovery, lower risk of thromboembolic complications, and postoperative infections. Obesity is closely associated with medical co-morbidities including diabetes, cardiovascular disease, and osteoarthritis, and also a major risk factor for endometrial cancer.…”

“…Patients with endometrial cancer often are both obese and elderly, which makes comprehensive laparoscopic surgical staging difficult, and surgeons often prefer to perform a laparotomy. [6][7][8] A recent study reported that 68% of women with early-stage endometrial cancer are obese. 9 Other factors such as adhesive disease, large uteri, fatty mesentery, impaired tolerance to Trendelenburg position, and surgical skills have lim-ited widespread use of this approach.…”

Risk Management of Obese Women Undergoing Major Gynaecological Surgery

“…Class 1obesity is a BMI between 30 and 34.9, class 2 between 35 and 39.9 and class 3 a BMI above 40 [3]. The general accepted definition of morbidly obese is a BMI greater than 40 [1]. Individuals with a BMI > 35 and comorbidity should be managed as for those with a BMI > 40.…”

“…Obesity is defined as an excess of adipose tissue [1]. In 1997, the WHO attempted to standardise the definition of obesity as a BMI above 30 kg/m 2 [2].…”