title: Laparoscopy and body mass index: feasibility and outcome in obese patients treated for gynecologic diseases.
abstract: OBJECTIVE
  To compare feasibility and surgical outcome of laparoscopic gynecologic surgery between obese, overweight, normal-weight, and underweight women.
  
  
  METHODS
  Retrospective case control study (Canadian Task Force classification II-3).
  
  
  METHODS
  Surgery Unit of Minimally Invasive Gynaecology.
  
  
  METHODS
  A total of 503 women who underwent laparoscopic procedures for both benign disease and malignancies.
  
  
  METHODS
  Four main categories of gynecologic disease were identified: uterine fibroids, benign adnexal masses, endometriosis, and endometrial cancer (stage I). For each category patients were divided into 4 groups: underweight (BMI <18.5 kg/m(2)), normal-weight (BMI 18.5-24.9 kg/m(2)), overweight (BMI 25-29.9 kg/m(2)), and obese (BMI ≥30 kg/m(2)).
  
  
  RESULTS
  Selected outcomes were duration of surgery, rate of laparotomy conversion, intraoperative and postoperative complications, and duration of hospital stay. No statistical difference regarding demographic data, surgical and medical history, and intraoperative findings was present between groups. No laparotomy conversion occurred. Regarding duration of surgery, we found no statistical difference among the BMI groups with regard to benign diseases, whereas pelvic lymphadenectomy in obese patients with endometrial cancer had a statistically significant longer duration than in the control group (122 +/- 47 min vs 65 +/- 21 min, p <.001). The postoperative complication rate was 0.01%: 3 cases of blood transfusion and 1 case of hemoperitoneum among myomectomies; 1 ureteral fistula in surgery for pelvic endometriosis; and 1 case of postoperative lymphocele in endometrial cancer group. No statistically significant difference was found in duration of hospital stay among the BMI groups in any of the categories of disease. For each category we conducted an analysis to identify any possible risk factors other than BMI in the surgical outcomes.
  
  
  CONCLUSIONS
  Laparoscopic approach in the various applications of gynecologic surgery does not appear to be significantly influenced by BMI in terms of surgical outcomes, laparotomy conversion rate, intraoperative and postoperative complications rate, and duration of hospital stay. The technical difficulties can be solved if skilled surgeons and anesthetists are available.
authors.affiliation: GINTEAM, Unit of Minimally Invasive Gynaecology, Turin, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Camanni
authors.forename: Luca
authors.initials: L
authors.lastname: Bonino
authors.forename: Elena Maria
authors.initials: EM
authors.lastname: Delpiano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Migliaretti
authors.forename: Paola
authors.initials: P
authors.lastname: Berchialla
authors.forename: Francesco
authors.initials: F
authors.lastname: Deltetto
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005240:Feasibility Studies; D005260:Female; D005831:Genital Diseases, Female / Q000150:complications* / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy; D007902:Length of Stay; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000601:surgery; D011183:Postoperative Complications; D012189:Retrospective Studies; D013851:Thinness / Q000150:complications* / Q000601:surgery