Robotic versus laparoscopic hysterectomy in morbidly obese women for endometrial cancer

Abstract

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.

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Authors

Contributions

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.

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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).

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

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

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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). https://doi.org/10.1007/s11701-020-01133-z

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Keywords

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