Influence of Morbid Obesity on Surgical Outcomes in Robotic-Assisted Gynecologic Surgery

Eddib, Abeer; Danakas, Alexandra; Hughes, S.; Erk, Mehmet Aykut; Michalik, C.; Narayanan, Madusudanan Sathia; Krovi, Venkat; Singhal, Pankaj

doi:10.1089/gyn.2012.0142

Cited by 32 publications

(17 citation statements)

References 21 publications

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“… 45.8 (41–52) 36.9 (28–48) 109± 207 (100–350) 1.4± 141± Almeida et al [ 41 ] PS 4 2011–2012 Benign 12 TLH Robot 44.4 (40–59) 44.1 (28–67) 109.6± 146.3± 1 (1–2) 259± Bernardini et al [ 42 ] a PS 4 2008–2010 Malign (mixed) 45 TLH Robot 40.3 (35–75) 61 (36–87) 270 (135–470) 200 (50–1500) 2 (1–24) NA (–) Bijen et al [ 8 ] a RCT 2b 2007–2009 Malign (no LND) 31 TLH Conv. NA (35–55) NA (–) NA (–) NA (–) NA (–) NA (–) Eddib et al [ 43 ] RS 4 2010–2012 Both (mixed LND) 84 TLH Robot 42.5± 50.4± 215.1± 79.3± …”

Section: Resultsmentioning

confidence: 99%

Hysterectomy in very obese and morbidly obese patients: a systematic review with cumulative analysis of comparative studies

Blikkendaal

Schepers

Zwet

et al. 2015

Arch Gynecol Obstet

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PurposeSome studies suggest that also regarding the patient with a body mass index (BMI) ≥35 kg/m2 the minimally invasive approach to hysterectomy is superior. However, current practice and research on the preference of gynaecologists still show that the rate of abdominal hysterectomy (AH) increases as the BMI increases. A systematic review with cumulative analysis of comparative studies was performed to evaluate the outcomes of AH, laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) in very obese and morbidly obese patients (BMI ≥35 kg/m2).MethodsPubMed and EMBASE were searched for records on AH, LH and VH for benign indications or (early stage) malignancy through October 2014. Included studies were graded on level of evidence. Studies with a comparative design were pooled in a cumulative analysis.ResultsTwo randomized controlled trials, seven prospective studies and 14 retrospective studies were included (2232 patients; 1058 AHs, 959 LHs, and 215 VHs). The cumulative analysis identified that, compared to LH, AH was associated with more wound dehiscence [risk ratio (RR) 2.58, 95 % confidence interval (CI) 1.71–3.90; P = 0.000], more wound infection (RR 4.36, 95 % CI 2.79–6.80; P = 0.000), and longer hospital admission (mean difference 2.9 days, 95 % CI 1.96–3.74; P = 0.000). The pooled conversion rate was 10.6 %. Compared to AH, VH was associated with similar advantages as LH.ConclusionsCompared to AH, both LH and VH are associated with fewer postoperative complications and shorter length of hospital stay. Therefore, the feasibility of LH and VH should be considered prior the abdominal approach to hysterectomy in very obese and morbidly obese patients.

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Section: Resultsmentioning

confidence: 99%

Hysterectomy in very obese and morbidly obese patients: a systematic review with cumulative analysis of comparative studies

Blikkendaal

Schepers

Zwet

et al. 2015

Arch Gynecol Obstet

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“…The authors reported similar results and concluded that RAH was feasible but required training and special expertise. Another study by Eddib et al ( 28 ) examined the impact of BMI on surgical outcomes of RAH. They concluded that procedure time was longer in morbidly obese patients; however, obesity had no impact on other outcomes.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of robotic, laparoscopic, and open hysterectomy for benign conditions in obese patients

Borahay¹,

Tapisiz²,

Alanbay³

et al. 2018

J Turkish German Gynecol Assoc

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Objective:To compare outcomes of robotic-assisted (RAH), total laparoscopic hysterectomy (LH), and total abdominal hysterectomy (TAH) for benign conditions in obese patients.Material and Methods:Retrospective cohort (Class II-2) analysis. All obese patients who underwent RAH, LH or TAH for benign conditions by a single surgeon at the University of Texas Medical Branch between January 2009 and December 2011 were identified and their charts reviewed. The patients’ characteristics, operative data, and post-operative outcomes were collected and statistically analyzed.Results:A total of 208 patients who underwent RAH (n=51), LH (n=24) or TAH (n=133) were analyzed. There were no significant differences among the groups in demographic characteristics, indications for surgery or pathologic findings. RAH and LH were associated with lower estimated blood loss (EBL) (p<0.001) and shorter length of hospital stay (LOS) (p<0.001) compared with TAH. In addition, RAH and LH had lower intraoperative and early postoperative (≤6 weeks) complications compared with TAH (p=0.002). However, the procedure time was longer in RAH and LH (p<0.001). No significant differences were noted among the groups for late post-operative complications (after 6 weeks) or unscheduled post-operative visits.Conclusion:Minimally invasive hysterectomy appears to be safe in obese patients with the advantages of less EBL, fewer intraoperative complications, and shorter LOS.

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“…These results for robotic hysterectomy are in accordance with another study, in which patients classified as morbidly obese showed higher operative times than those who were not (BMI < 35). 17 No correlation between uterine weight and operative time has been shown in the literature. 18,19 In agreement to that, no correlation between the total operative time and the uterine weight, or between the total operative time and the number of previous abdominal surgeries was observed in the present study.…”

Section: Discussionmentioning

confidence: 99%

Early Experience of Robotic Hysterectomy for Treatment of Benign Uterine Disease

Gutiérrez

Binda

Ramos

2016

Rev Bras Ginecol Obstet

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To demonstrate the initial experience of robotic hysterectomy to treat benign uterine disease at a university hospital in Brazil. A cross-sectional study was conducted to review data from the first twenty patients undergoing robotic hysterectomy at our hospital. The surgeries were performed from November 2013 to August 2014, all of them by the same surgeon. The patients were reviewed for preoperative characteristics, including age, body mass index (BMI), indications for the hysterectomy and previous surgeries. Data of operative times, complications, postoperative pain and length of hospital stay were also collected. The total operating room time was 252.9 minutes, while the operative time was 180.7 minutes and the console time was 136.6 minutes. Docking time was 4.2 minutes, and the average undocking time was 1.9 minutes. There was a strong correlation between the operative time and the patient's BMI ( = 0.670; = 0.001). The console time had significant correlation with the uterine weight and the patient's BMI ( = 0.468; = 0.037). A learning curve was observed during docking and undocking times. Despite its high cost, the robotic surgery is gaining more space in gynecological surgery. By the results obtained in our hospital, this surgical proposal proved to be feasible and safe. Our initial experience demonstrated a learning curve in some ways.

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Influence of Morbid Obesity on Surgical Outcomes in Robotic-Assisted Gynecologic Surgery

Cited by 32 publications

References 21 publications

Hysterectomy in very obese and morbidly obese patients: a systematic review with cumulative analysis of comparative studies

Hysterectomy in very obese and morbidly obese patients: a systematic review with cumulative analysis of comparative studies

Outcomes of robotic, laparoscopic, and open hysterectomy for benign conditions in obese patients

Early Experience of Robotic Hysterectomy for Treatment of Benign Uterine Disease

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