Robot-assisted total laparoscopic hysterectomy in obese and morbidly obese women |
| |
Authors: | Sonia A Rebeles Howard G Muntz Carrie Wieneke-Broghammer Emily S Vason Kathryn F McGonigle |
| |
Institution: | (1) Northwest Hospital and Medical Center, Seattle, USA;(2) Present address: Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at El Paso, 4800 Alberta Ave., El Paso, TX 79905, USA;(3) Present address: Department of Obstetrics and Gynecology, Center for Minimally Invasive and Robotic Surgery, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA; |
| |
Abstract: | Total laparoscopic hysterectomy (TLH) in obese patients is challenging. We sought to evaluate whether total laparoscopic hysterectomies
using the da Vinci robotic system in obese patients, in comparison with non-obese patients, is a reasonable surgical approach.
One-hundred consecutive robot-assisted TLHs were performed over a 17-month period. Obesity was not a contraindication to robotic
surgery, assuming adequate respiratory function to tolerate Trendelenburg position and, for cancer cases, a small enough uterus
to allow vaginal extraction without morcellation. Data were prospectively collected on patient characteristics, total operative
time, hysterectomy time, estimated blood loss, length of stay, and complications. Outcomes with non-obese and obese women
were compared. The median age, weight, and BMI of the 100 patients who underwent robot-assisted TLH was 57.6 years (30.0–90.6),
82.1 kg (51.9–159.6), and 30.2 kg/m2 (19.3–60.2), respectively. Fifty (50%) patients were obese (BMI ≥ 30); 22 patients were morbidly obese (BMI ≥ 40). There
was no increase in complications (p = 0.56) or blood loss (p = 0.44) with increasing BMI. While increased BMI was associated with longer operative times (p = 0.05), median time increased by only 36 min when comparing non-obese and morbidly obese patients. Median length of stay
was one day for all weight categories (p = 0.42). Robot-assisted TLH is feasible and can be safely performed in obese patients. More data are needed to compare robot-assisted
TLH with other hysterectomy techniques in obese patients. Nonetheless, our results are encouraging. Robot-assisted total laparoscopic
hysterectomy may be the preferred technique for appropriately selected obese patients. |
| |
Keywords: | |
本文献已被 SpringerLink 等数据库收录! |
|