title: Computed Tomography Morphometrics and Pulmonary Intolerance in Endometrial Cancer Robotic Surgery.
abstract: To identify morphometric characteristics of obese patients that best predict pulmonary intolerance to robotic pelvic surgery using a novel method for quantifying adipose distribution.
  
  
  
  Retrospective study (Canadian Task Force classification II-2).
  
  
  
  University hospital.
  
  
  
  Fifty-nine patients with endometrial cancer who underwent robotic hysterectomy and lymphadenectomy between April 2008 and May 2014 and also underwent perioperative computed tomography (CT) imaging within 1 year.
  
  
  
  Visceral fat volume (VFV) and subcutaneous fat volume (SFV) were quantified through waist circumference measurements along with average volume estimation of slices taken at 3 levels: mid-waist, L2-L3, and L4-L5. Mean and maximum values were obtained for intraoperative physiological data.
  
  
  
  The patients' mean body mass index (BMI) was 34 (range, 20-59). Along with waist circumference, VFV and SFV quantified by CT at the mid-waist, L2-L3, and L4-L5 levels were all significant independent predictors for peak airway pressure (PAP; average and maximum) and plateau airway pressure (Pplat; average and maximum) on multivariate regression analysis after adjustment for age, ethnicity, diabetes, hypertension, pulmonary disease, smoking, obstructive sleep apnea, American Society of Anesthesiologists classification, and duration of anesthesia. Compared with the other CT parameters, L2-L3 VFV was the best predictor of average PAP (β = 0.398; p = .002), maximum PAP (β = 0.493; p < .001), average Pplat (β = 0.536; p < .001), and maximum Pplat (β = 0.573; p < .001).
  
  
  
  These novel CT morphometric measurements represent valid predictors of pulmonary intolerance to robotic surgery in obese patients. Of the measures analyzed, VFV at L2-L3 best predicts pulmonary tolerance in obese patients.
authors.affiliation: Department of Reproductive Biology, University Hospitals Case Medical Center, Cleveland, OH; Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt.
authors.forename: Ahmed Y
authors.initials: AY
authors.lastname: Abdelbadee
authors.affiliation: Radiology Department, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Raj M
authors.initials: RM
authors.lastname: Paspulati
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Heather D
authors.initials: HD
authors.lastname: McFarland
authors.affiliation: Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt; Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Colombia, Vancouver, BC, Canada.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Bedaiwy
authors.affiliation: Radiology Department, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Leslie
authors.initials: L
authors.lastname: Ciancibello
authors.affiliation: Radiology Department, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Gina
authors.initials: G
authors.lastname: Anderson
authors.affiliation: Department of Reproductive Biology, University Hospitals Case Medical Center, Cleveland, OH. Electronic address: Kristine.Zanotti@UHhospitals.org.
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Zanotti
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D018269:Carcinoma, Endometrioid / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D008197:Lymph Node Excision; D008875:Middle Aged; D056128:Obesity, Abdominal; D011183:Postoperative Complications; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D014057:Tomography, X-Ray Computed
keywords: Computed tomography morphometrics; Endometrial cancer; Pulmonary intolerance; Robotic pelvic surgery; Visceral adiposity