title: What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman?
abstract: OBJECTIVE
  Thirty-three percent of U.S. women are either obese or morbidly obese. This is associated with an increased risk of death from all causes and is also associated with an increased risk of endometrial carcinoma. We sought to compare minimally invasive surgical techniques for staging the obese and morbidly obese woman with endometrial cancer.
  
  
  METHODS
  Consecutive robotic endometrial cancer staging procedures were collected from 2005-2007 and were compared to consecutive laparoscopic cases (2000-2004). Demographics including age, weight, body mass index (BMI), operative time, estimated blood loss, lymph node retrieval, hospital stay and complications were collected and compared.
  
  
  RESULTS
  During the study period, there were 36 obese and 13 morbidly obese women who underwent surgery with the DaVinci robotic system and 25 obese and 7 morbidly obese women who underwent traditional laparoscopy. For both the obese and morbidly obese patient, robotic surgery was associated with shorter operative time (p=0.0004), less blood loss (p<0.0001), increased lymph node retrieval (p=0.004) and shorter hospital stay (p=0.0119).
  
  
  CONCLUSIONS
  Robotic surgery is a useful minimally invasive tool for the comprehensive surgical staging of the obese and morbidly obese woman with endometrial cancer. As this patient population is at increased risk of death from all causes, including post-operative complications, all efforts should be made to improve their outcomes and minimally invasive surgery provides a useful platform by which this can occur.
authors.affiliation: Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Paola_Gehrig@med.unc.edu
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Cantrell
authors.forename: Aaron
authors.initials: A
authors.lastname: Shafer
authors.forename: Lisa N
authors.initials: LN
authors.lastname: Abaid
authors.forename: Alberto
authors.initials: A
authors.lastname: Mendivil
authors.forename: John F
authors.initials: JF
authors.lastname: Boggess
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007828:Laryngoscopy / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D009765:Obesity / Q000150:complications*; D009767:Obesity, Morbid / Q000150:complications*; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods