title: A cohort study evaluating robotic versus laparotomy surgical outcomes of obese women with endometrial carcinoma.
abstract: OBJECTIVE
  Minimally invasive surgery offers advantages for management of obese patients, but technical difficulty often deters its utilization. Compared to laparotomy, robotic surgery should allow comparable staging and improved surgical outcomes. Therefore, we evaluated outcomes in robotic and laparotomy cohorts of obese women with endometrial cancer at our institution.
  
  
  METHODS
  Retrospective robotic and laparotomy cohorts of obese women (BMI ≥ 30 kg/m(2)) undergoing surgical management of primary endometrial cancer from March 2006 to March 2009 were formulated utilizing a computerized database. Patient demographics, operative statistics, peri-operative complications, and pathologic details were collected in an intent to treat analysis. Chi-square or Fisher's exact test and t-test were used for statistical analysis.
  
  
  RESULTS
  73 women underwent robotic surgical management, 11% converted to laparotomy. Mean BMI (39.8 vs. 41.9, p=0.152), number of co-morbidities (2.49 vs. 2.62, p=0.690), number of previous surgeries (0.97 vs. 0.94, p=0.841), and lymphadenectomies performed (65.8% vs. 56.7%, p=0.227) were similar between cohorts. Total lymph nodes obtained were not statistically different between cohorts (8.01 vs. 7.24, p=0.505). Total operative time and room time was significantly longer for robotic surgery; however, estimated blood loss, the percentage of patients receiving transfusion, hospital length of stay, wound complications (4.1% vs. 20.2%, p=0.002) and other complications (9.6% vs. 29.8%, p=0.001) were improved for the robotic cohort.
  
  
  CONCLUSIONS
  Robotic management of obese women with endometrial cancer yields acceptable staging results and improved surgical outcomes. Although operating time is longer, hospital time is shorter. Robotic surgery may be an ideal approach for these patients.
authors.affiliation: Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35223, USA. akila.subramaniam@gmail.com
authors.forename: Akila
authors.initials: A
authors.lastname: Subramaniam
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Kim
authors.forename: Shannon A
authors.initials: SA
authors.lastname: Bryant
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.forename: Christa
authors.initials: C
authors.lastname: Sikes
authors.forename: Kristopher J
authors.initials: KJ
authors.lastname: Kimball
authors.forename: Larry C
authors.initials: LC
authors.lastname: Kilgore
authors.forename: Warner K
authors.initials: WK
authors.lastname: Huh
authors.forename: John M
authors.initials: JM
authors.lastname: Straughn
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Alvarez
mesh_terms: D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000150:complications* / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007813:Laparotomy / Q000379:methods; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000503:physiopathology; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods; D016896:Treatment Outcome