Robotic versus laparoscopic hysterectomy in morbidly obese women for endometrial cancer


Surgery is the mainstay treatment for endometrial cancer and complex atypical endometrial hyperplasia. These conditions are more common in the obese women and as such these patients pose additional risks and challenges to surgery. Laparoscopic hysterectomy (LH) is preferred over open surgery in obese patients as it reduces surgical morbidity. However, more recently, robotic-assisted hysterectomy (RH) has been used in morbidly obese patients to overcome the limitations of conventional laparoscopy. To compare the surgical outcomes of morbidly obese patients undergoing LH or RH for endometrial cancer or complex atypical hyperplasia. A retrospective analysis of morbidly obese patients (BMI > 40 kg/m2) who underwent LH or RH for endometrial cancer or complex atypical hyperplasia at the Chris O’Brien Lifehouse Gynaecological Oncology Unit from 2015 to 2019 was performed. Data was collected from the prospectively maintained gynaecology oncology database and descriptive analysis was performed. 33 (51.6%) underwent LH and 31 (48.4%) had RH. More LHs were performed 2015–2017 period, whereas there were more RHs performed in 2018–2019 period (p = 0.01). The difference between theatre time use and operating time for LH surgery compared to RH was significantly shorter (45.7 for LH versus 61.9 min for RH, p = 0.009). RH was performed more commonly when BMI was > 50 kg/m2 (p = 0.02). There has been an increase in the use of RH in morbidly obese patients, particularly for women with a BMI > 50 kg/m2.

This is a preview of subscription content, log in to check access.

Availability of data and material

All relevant data are available.


  1. 1.

    Endometrial cancer statistics. Australian Government. [Cited 20/12/2019]. Accessed 20 Dec 2019

  2. 2.

    Mills AM, Longacre TA (2010) Endometrial hyperplasia. Semin Diagn Pathol 27:199–214

    PubMed  Article  Google Scholar 

  3. 3.

    Laaksonen MA, Arriaga ME, Canfell K, MacInnis RJ, Byles JE, Banks E, Shaw JE, Mitchell P, Giles GG, Magliano DJ, Gill TK, Klaes E, Velentzis LS, Hirani V, Cumming RG, Vajdic CM (2019) The preventable burden of endometrial and ovarian cancers in Australia: a pooled cohort study. Gynecol Oncol 153(3):580–588

    PubMed  Article  Google Scholar 

  4. 4.

    A picture of overweight and obesity in Australia 2017. Australian Institute of Health and Welfare. [Cited 22/1/2020]. Accessed 22 Jan 2020

  5. 5.

    Chan JK, Gardner AB, Taylor K, Thompson CA, Blansit K, Yu X, Kapp DS (2015) Robotic versus laparoscopic versus open surgery in morbidly obese endometrial cancer patients—a comparative analysis of total charges and complication rates. Gynecol Oncol 139(2):300–305

    PubMed  Article  Google Scholar 

  6. 6.

    Calle EE, Rodriquez C, Walker-Thurmond K et al (2003) Overweight, obesity and mortality from cancer in prospectively studied cohort of U.S. adults. N Engl J Med 348:1625–1638

    PubMed  Article  Google Scholar 

  7. 7.

    Gehrig PA, Cantrell LA, Shafer A, Abaid LN, Mendivil A, Boggess JF (2008) What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman? Gynecol Oncol 111(1):41–45

    PubMed  Article  Google Scholar 

  8. 8.

    Janda M, Gebski V, Forder P et al (2006) Total laparoscopic versus open surgery for stage 1 endometrial cancer: the LACE randomized controlled trial. Contemp Clin Trials 27:353–363

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Janda M, Gebski V, Davies LC et al (2017) Effect of total laparoscopic hysterectomy vs total abdominal hysterectomy on disease-free survival among women with stage i endometrial cancer: a Randomized Clinical Trial. JAMA 317(12):1224–1233

    PubMed  Article  Google Scholar 

  10. 10.

    Agha R, Muir G (2003) Does laparoscopic surgery spell the end of the open surgeon? J R Soc Med 96(11):544–546

    PubMed  PubMed Central  Article  Google Scholar 

  11. 11.

    Lamvu G, Zolnoun D, Boggess J, Steege JF (2004) Obesity: physiologic changes and challenges during laparoscopy. Am J Obstet Gynecol 191:669–674

    PubMed  Article  Google Scholar 

  12. 12.

    daVinci Systems. Cited 22/1/2020. Available from: Accessed 22 Jan 2020

  13. 13.

    Committee opinion no (2015) 628: robotic surgery in gynecology. Obstet Gynecol 125:760–767

    Article  Google Scholar 

  14. 14.

    Committee on Gynecologic Practice (2015) Committee opinion no. 619: gynecologic surgery in the obese woman. Obstet Gynecol 125:274–278

    Article  Google Scholar 

  15. 15.

    Kakde AS, Wagh HD (2017) An observational study: effects of tenting of the abdominal wall on peak airway pressure in robotic radical prostatectomy surgery. Saudi J Anaesth 11:279–282

    PubMed  PubMed Central  Article  Google Scholar 

  16. 16.

    Leitao MM, Narain WR, Boccamazzo D et al (2016) Impact of robotic platforms on surgical approach and costs in the management of morbidly obese patients with newly diagnosed uterine cancer. Ann Surg Oncol 23(7):2192–2198

    PubMed  PubMed Central  Article  Google Scholar 

  17. 17.

    Seaman LG, Cohn DE, Richardson DL, Valmadre S, Carlson MJ, Phillips GS, Fowler JM (2008) Robotic hysterectomy and pelvic- aortic lymphadenectomy for endometrial cancer. Obstet Gynecol 112(6):1207–1213

    Article  Google Scholar 

  18. 18.

    Lau S, Buzaglo K, Vaknin Z et al (2011) Relationship between body mass index and robotic surgery outcomes of women diagnosed with endometrial cancer. Int J Gynecol Cancer 21:722–729

    PubMed  Article  Google Scholar 

  19. 19.

    Bernardini MQ, Gien LT, Tipping H, Murphy J, Rosen BP (2012) Surgical outcome of robotic surgery in morbidly obese patient with endometrial cancer compared to laparotomy. Int J Gynecol Cancer 22:76–81

    PubMed  Article  Google Scholar 

  20. 20.

    Stephan J, Goodheart MJ, McDonald M, Hansen J, Reyes HD, Button A, Bender D (2015) Robotic surgery in supermorbidly obese patients with endometrial cancer. Am J Obstet Gynecol 213(1):49.e1–49.e8

    Article  Google Scholar 

  21. 21.

    Cusimano MC, Simpson AN, Dossa F et al (2019) Laparoscopic and robotic hysterectomy in endometrial cancer patients with obesity: a systematic review and meta-analysis of conversions and complications. Am J Obstet Gynecol 221(5):410–428.e19

    PubMed  Article  Google Scholar 

  22. 22.

    Walker JL, Piedmonte MR, Spirtos NM et al (2009) Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: gynecologic Oncology Group Study LAP2. J Clin Oncol 27:5331–5336

    PubMed  PubMed Central  Article  Google Scholar 

  23. 23.

    Oehler MK (2011) Robotic surgery in gynaecology and gynaecological oncology: Program initiation and operative outcomes at the. Aust NZ J Obstet and Gynaecol 51:119–124

    Article  Google Scholar 

  24. 24.

    Nightingale CE, Margarson MP, Shearer E et al (2015) Peri-operative management of the obese surgical patient 2015. Anaesthesia 70(7):859–876

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  25. 25.

    Wright JD, Ananth CV, Lewin SN et al (2013) Robotically assisted vs laparoscopic hysterectomy among women with benign gynecologic disease. JAMA 309(7):689–698

    CAS  PubMed  Article  Google Scholar 

  26. 26.

    Cardenas-Goicoechea J, Adams S, Bhat SB, Randall TC (2010) Surgical outcomes of robotic-assisted surgical staging for endometrial cancer are equivalent to traditional laparoscopic staging at a minimally invasive surgical center. Gynecol Oncol 117(2):224–228

    PubMed  PubMed Central  Article  Google Scholar 

  27. 27.

    Sarlos D, Kots L, Stevanovic N, Schaer G (2010) Robotic hysterectomy versus conventional laparoscopic hysterectomy: outcome and cost analyses of a matched case-control study. Eur J Obstet Gynecol Reprod Biol 150(1):92–96

    PubMed  Article  Google Scholar 

Download references


No funding was obtained to conduct this research.

Author information




Dr El-Achi contributed to intellectual planning of the project, data collection, intellectual analysis of the data and writing of the manuscript. Professor Carter and A/Professor Saidi contributed to intellectual planning and revision of the paper. Dr. Weishaupt contributed to data collection and revision of the paper.

Corresponding author

Correspondence to Vanessa El-Achi.

Ethics declarations

Conflict of interest

Vanessa El-Achi, Jennifer Weishaupt, Jonathan Carter and Sam Saidi declare that they have no conflict of interest.

Ethics approval

This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research standards, and in line with the principles of the Declaration of Helsinki. Ethics approval was obtained from the Sydney Local Health District and Chris O’Brien Lifehouse (X19-099 & 2019/ETH13958, LH19.058).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Research was carried out at in the Gynaecology Oncology Department at Chris O’Brien Lifehouse, Sydney, Australia.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

El-Achi, V., Weishaupt, J., Carter, J. et al. Robotic versus laparoscopic hysterectomy in morbidly obese women for endometrial cancer. J Robotic Surg (2020).

Download citation


  • Robotic-assisted surgery
  • Laparoscopy
  • Hysterectomy
  • Minimally invasive surgery
  • Endometrial cancer
  • Endometrial hyperplasia