title: Outcomes of obese versus non-obese subjects undergoing robotic-assisted hysterectomy: a multi-institutional study.
abstract: The goal of our study was to determine whether there was a difference in operative outcomes in obese versus non-obese subjects undergoing robotic-assisted hysterectomies of varying levels of difficulty. Secondarily, we sought to analyze the published outcomes between robotic-assisted hysterectomy and total laparoscopic hysterectomy in obese women at each of these levels of difficulty. This was a multi-institutional retrospective cohort study of all patients undergoing robotic-assisted hysterectomy by five gynecologic oncologists at four geographically separate locations from April 2003 to March 2008. The cohort was stratified into obese vs. non-obese groups, and defined surgical outcomes compared between groups, then further divided into three subgroups based on case difficulty level. Univariate analysis and regression analysis using SAS 9.1 was performed. We then conducted a literature search of total laparoscopic hysterectomy outcomes in obese women, dividing the resulting studies into three comparative subgroups based on surgical difficulty levels for comparison with our robotic-assisted hysterectomy results. Our cohort had 228 obese and 323 non-obese subjects. Overall, the obese group had higher blood loss and longer operative time. When further stratified by level of difficulty, obese subjects also had a higher average blood loss and longer operative time in the hysterectomy-alone subgroup. No clinically significant differences in operative outcomes exist between obese and non-obese women when utilizing the da Vinci robotic system to perform a hysterectomy, independent of case difficulty level. More prospective, controlled studies which compare the two surgical approaches of robotic-assisted and laparoscopic hysterectomy approaches are needed.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Vermont, 800 Colchester Avenue, Burlington, VT, 05403, USA. wbdaven@gmail.com.
authors.forename: W B
authors.initials: WB
authors.lastname: Davenport
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University, Chicago, IL, USA.
authors.forename: M P
authors.initials: MP
authors.lastname: Lowe
authors.affiliation: University of Tennessee, Chattanooga, Gynecologic Oncology, Chattanooga, TN, USA.
authors.forename: D H
authors.initials: DH
authors.lastname: Chamberlin
authors.affiliation: Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Aurora Health Center, Milwaukee, WI, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Kamelle
authors.affiliation: Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Aurora Health Center, Milwaukee, WI, USA.
authors.forename: P R
authors.initials: PR
authors.lastname: Johnson
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Texas Southwestern, Dallas, TX, USA.
authors.forename: M
authors.initials: M
authors.lastname: Tyndall
authors.affiliation: Department of Obstetrics and Gynecology and The West Clinic, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: T D
authors.initials: TD
authors.lastname: Tillmanns
keywords: Laparoscopic; Obese; Robotic-assisted hysterectomy; Surgical outcomes; Total laparoscopic hysterectomy; da Vinci