title: Surgical outcome of robotic surgery in morbidly obese patient with endometrial cancer compared to laparotomy.
abstract: BACKGROUND
  Before the introduction of robotic surgery at our institution, most obese women of class 2 or greater (body mass index [BMI] >35) underwent a laparotomy for the management of endometrial cancer. Since November 2008, we have performed most of these cases in a robotic fashion. This manuscript presents the outcome of these women in comparison with a historical cohort of women treated with laparotomy.
  
  
  METHODS
  Women with clinical stage I or II endometrial cancer and a BMI greater than 35 kg/m treated with robotic surgery at our institution between November 2008 and November 2010 were compared with a historical cohort of similar patients who underwent laparotomy. Patients' characteristics, operating room time, type of surgery, length of hospital stay, and incidence of perioperative complications were compared between the 2 groups.
  
  
  RESULTS
  A total of 86 women were analyzed in this study (robotic surgery, 45; laparotomy, 41). The overall intraoperative complication rate is 5.8%. There is no statistical difference in age, number of comorbidities, BMI, prior abdominal surgery, and operative complications between the women who underwent robotic surgery versus laparotomy. Postoperative complication rates are higher in the laparotomy group (44% vs 17.7%; P = 0.007), and hospital length of stay is also higher in the laparotomy group (4 vs 2 days; P < 0.001). There is no difference in rates of (pelvic) lymph node dissection; however, para-aortic node dissection is more common in the robotic surgery group.
  
  
  CONCLUSIONS
  Robotic surgery for the surgical management of the morbidly obese patient is shown to be safe and have less perioperative complications compared with open surgery.
authors: Division of Gynecologic Oncology, Princess Margaret Hospital, Ontario, Canada. Marcus.bernardini@uhn.on.ca
authors: Marcus Q
authors: MQ
authors: Bernardini
authors: Lilian T
authors: LT
authors: Gien
authors: Helen
authors: H
authors: Tipping
authors: Joan
authors: J
authors: Murphy
authors: Barry P
authors: BP
authors: Rosen
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000150:complications / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002296:Carcinosarcoma / Q000150:complications / Q000601:surgery; D016889:Endometrial Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000295:instrumentation / Q000379:methods*; D007431:Intraoperative Complications / Q000453:epidemiology; D007813:Laparotomy; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D009767:Obesity, Morbid / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012371:Robotics; D016896:Treatment Outcome