Total laparoscopic hysterectomy for early stage endometrial cancer in obese and morbidly obese women

Abstract

This is a retrospective observational study, where we have evaluated the role of total laparoscopic hysterectomy (TLH) in obese and morbidly obese patients with early stage endometrial cancer. Our study illustrates that low conversion rates are achievable when appropriately trained surgeons undertake this procedure. All the women with high BMI were operated on laparoscopically in preference to laparotomy, unless there was an obvious contraindication such as a very large uterus or disseminated disease. We have also shown low conversation and complication rates for our patients, in particular a low rate of wound infection. This is in contrast to the high rate of wound infection and prolonged hospital stay reported for obese patients in the literature. Our study shows that TLH for endometrial cancer in obese women is feasible, safe and is likely to be cost-effective and adds to the weight of evidence for its use in this condition.

Feasibility and Safety of Laparoscopic Surgery for Obese Korean Women with Endometrial Cancer: Long-Term Results at a Single Institution

“…Farthing et al (19) reported a short operative time and low EBL compared to previous studies, including our study. This is probably due to the relatively low rate of lymph- adenectomy of 3.1%.…”

“…The rate of conversion to laparotomy in laparoscopic surgery was 1.04% to 10.6% in previous studies (18,19,27,37). In contrast, Walker et al (36) and Scribner et al (38) reported the conversion rate in their studies as 25.8% and 36.4%, respectively.…”

“…Walker et al reported that 98.3% of their patients underwent lym phadenectomy and 91.9% underwent para-aortic lymphadenectomy, and Scribner et al reported the utility of laparoscopy in lymphadenectomy and all patients in this study underwent pelvic and para-aortic lymphadenectomy (36,38). In contrast, Farthing et al (19) performed lymphadenectomy in 3.1% of all of their patients. Eltabbakh et al performed pelvic lymphadenectomy in 77.5% of their patients and para-aortic lymphadenectomy in 17.5% of the patients in his earlier study, and with 75.7% for pelvic and 21.1% for para-aortic lymphadenectomy in his later study, while Obermair et al performed lymphadenectomy in 67.8% of their patients (18,27,37).…”

“…Obesity was once a contraindication for advanced laparoscopic procedures (15,16), although this has recently been reconsidered (17). Improved instrumentation and techniques have allowed the safe use of many advanced laparoscopic procedures in women with a high BMI (18)(19)(20)(21)(22). However, there are few reports regarding the feasibility of laparoscopic hysterectomy and dissection of the pelvic or both the pelvic and para-aortic lymph nodes in obese Korean women.…”

Laparoscopy versus laparotomy for the management of endometrial carcinoma in morbidly obese patients: a prospective study

“…However, it has been shown that obese patients are benefitted more from laparoscopy. Laparoscopic staging of EC in obese or morbidly obese patients results in fewer operative complications and faster recovery (8)(9)(10)(11). The aim of this study was to compare the laparoscopic approach with laparotomy in morbidly obese Turkish women with early stage EC women with similar clinical characteristics.…”