title: Complications of Robotic Gynecologic Surgery in the Severely Morbidly Obese.
abstract: Surgeons are increasingly faced with the challenge of caring for obese patients. Advanced laparoscopic procedures have been shown to be safe in women with high BMI, but conversion rates remain high. Because robotics holds many potential advantages over traditional laparoscopic surgery, we sought to evaluate the outcome of robotic-assisted gynecologic surgery in obese patients.
  
  
  
  A retrospective chart review of obese female patients undergoing robotic gynecologic surgery between January 2008 and August 2010 was done. Patients were divided into three groups based on BMI (group I, BMI 30-34.9 kg/m2; group II, BMI 35-39.9 kg/m2; and group III, BMI >40 kg/m2). Patients were assessed for baseline characteristics, comorbid conditions, and surgical outcomes and complications.
  
  
  
  A total of 128 obese patients were identified with 43 in group I, 30 in group II, and 55 in group III. There was an increased prevalence of diabetes and asthma in group III and younger age in group I. Of the 128, 117 (91 %) underwent hysterectomy and/or staging with the majority of patients having surgery for either endometrial cancer or fibroids. Conversion to laparotomy was more common in groups 2 and 3 with a positive correlation between increasing BMI and conversion. There was no difference in complications between the groups and only 1 major postoperative complication in the entire cohort.
  
  
  
  Robotic-assisted gynecologic surgery can be safely performed in severely morbidly obese patients. Although conversion rates are higher with increasing obesity, a majority of procedures can still be completed minimally invasively.
authors.affiliation: Gynecologic Oncology, The Hospital of Central Connecticut, Hartford Health Care Cancer Institute, New Britain, CT, USA. jonathan.cosin@hhchealth.org.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Cosin
authors.affiliation: Department of Obstetrics and Gynecology, Medstar Washington Hospital Center, Washington, DC, USA.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Brett Sutherland
authors.affiliation: St. Helena Women's Center, St. Helena, CA, USA.
authors.forename: Candace T
authors.initials: CT
authors.lastname: Westgate
authors.affiliation: Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC, USA.
authors.forename: Hongbin
authors.initials: H
authors.lastname: Fang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D061887:Conversion to Open Surgery; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D009367:Neoplasm Staging; D009767:Obesity, Morbid / Q000150:complications*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects*