title: Laparoscopy versus laparotomy for the management of endometrial carcinoma in morbidly obese patients: a prospective study.
abstract: OBJECTIVE
  To compare the results of total laparoscopic hysterectomy and total abdominal hysterectomy in morbidly obese women with early stage endometrial cancer.
  
  
  METHODS
  This prospective study was conducted on 140 morbidly obese women with body mass indices ≥35 kg/m(2) and presenting with clinical stage 1 endometrial cancer. The patients underwent total laparoscopic hysterectomy (n=70) or total abdominal hysterectomy (n=70), bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and peritoneal washing. Age, parity, menopausal status, weight, height, medical problems, history of previous laparotomy, surgical procedure, operative time, estimated amount of blood loss, preoperative hematocrit, postoperative hematocrit, operative complications, conversion to laparotomy, need for intraoperative or postoperative blood transfusion, intraoperative and postoperative complications, secondary surgery, tumor stage, grade, histology, number of recovered lymph nodes, and visual pain scores of the patients were recorded.
  
  
  RESULTS
  Postoperative complications were significantly higher in the laparotomy group. Hospital stay in the laparoscopy group was significantly lower than that in the laparotomy group. The visual pain scores were significantly higher in the laparotomy group on the first, second, and third postoperative days and on the day of discharge from the hospital. Resuming activity took a significantly longer time in the laparotomy group (34.70 days) than in the laparoscopic group (17.89 days).
  
  
  CONCLUSIONS
  With the availability of skilled endoscopic surgeons, most obese women with early stage endometrial cancer can be safely managed by performing laparoscopy with an excellent surgical outcome, shorter hospitalization, less postoperative pain, and faster resumption of full activity.
authors.affiliation: Department of Obstetrics and Gynecology, Tekirdağ Star Medica Hospital, Tekirdağ, Turkey.
authors.forename: Özgür
authors.initials: Ö
authors.lastname: Bige
authors.affiliation: Clinic of Obstetrics and Gynecology, Elazığ Training and Research Hospital, Elazığ, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Demir
authors.affiliation: Department of Obstetrics and Gynecology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey.
authors.forename: Bahadır
authors.initials: B
authors.lastname: Saatli
authors.affiliation: Department of Pathology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey.
authors.forename: Meral
authors.initials: M
authors.lastname: Koyuncuoğlu
authors.affiliation: Department of Obstetrics and Gynecology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey.
authors.forename: Uğur
authors.initials: U
authors.lastname: Saygılı
keywords: Laparoscopy; endometrial carcinoma; morbidly obese patients