title: Robot-assisted laparoscopic hysterectomy in obese and morbidly obese women: surgical technique and comparison with open surgery.
abstract: OBJECTIVE
  Comparison of surgical results on obese patients undergoing hysterectomy by robot-assisted laparoscopy or laparotomy.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  All women (n=114) with a BMI ≥30 kg/m(2) who underwent a simple hysterectomy as the main surgical procedure between November 2005 and November 2009 were identified. Robot-assisted procedures (n=50) were separated into an early (learning phase) and a late (consolidated phase) group; open hysterectomy was considered an established method. Relevant data was retrieved from prospective protocols (robot) or from computerized patient charts (laparotomy) until 12 months after surgery. Complications leading to prolonged hospital stay, readmission/reoperation, intravenous antibiotic treatment or blood transfusion were considered significant. The surgical technique used for morbidly obese patients is described.
  
  
  RESULTS
  Women in the late robot group (n=25) had shorter inpatient time (1.6 compared to 3.8 days, p<0.0001), less bleeding (100 compared to 300 mL, p<0.0001) and fewer complications (2/25 compared to 23/64, p=0.006) than women with open surgery (n=64) but a longer operating time (136 compared to 110 minutes, p=0.0004). For women with a BMI ≥35 kg/m(2) , surgical time in the late robot group and the laparotomy group was equal (136 compared to 128 minutes, p=0.31).
  
  
  CONCLUSIONS
  Robot-assisted laparoscopic hysterectomy in a consolidated phase in obese women is associated with shorter hospital stay, less bleeding and fewer complications compared to laparotomy but, apart from women with BMI ≥35, a longer operative time.
authors.affiliation: Department of Obstetrics and Gynecology, Skane University Hospital, Lund and Faculty of Medicine Lund University, Lund, Sweden.
authors.forename: Barbara
authors.initials: B
authors.lastname: Geppert
authors.forename: Celine
authors.initials: C
authors.lastname: Lönnerfors
authors.forename: Jan
authors.initials: J
authors.lastname: Persson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000295:instrumentation / Q000379:methods*; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay; D008137:Longitudinal Studies; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D011446:Prospective Studies; D012371:Robotics; D016896:Treatment Outcome