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Robotic assisted hysterectomy in obese patients: a systematic review

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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

Robotic hysterectomy is an alternative approach to the management of female genital tract pathology.

Methods

A systematic literature review was performed to evaluate the till now available literature evidence on robotic assisted hysterectomy in obese and morbidly obese patients.

Results

In total, robotic assisted hysterectomy was performed on 2769 patients. The most frequent indication for robotic hysterectomy was endometrial carcinoma (1832 out of 2769 patients, 66.2 %). Hypertension, diabetes mellitus, obstructive sleep apnea, chronic obstructive pulmonary disease and venous thromboembolism were the most common comorbidities reported. The conversion rate to laparotomy was 92 out of 2226 patients (4.1 %). The most frequent intraoperative complications for robotic hysterectomy were gastrointestinal injury (17 out of 2769 patients, 0.6 %), haemorrhage (five out of 2769 patients, 0.2 %) and bladder injury (five out of 2769 patients, 0.2 %). Wound infections/dehiscence (66 out of 2769 patients, 2.4 %), fever (56 out of 2769 patients, 2 %), pulmonary complications (55 out of 2769 patients, 1.9 %), urogenital complications (36 out of 2769 patients, 1.3 %) and postoperative ileus (28 out of 2769 patients, 1 %) were the most common postoperative complications. Death was reported in three out of 2769 patients (0.1 %). The ICU admitted patients were eight of 2226 patients (0.4 %).

Conclusion

The robotic technique, especially in obese, can optimize the surgical approach and recovery of such patients with equally if not better outcomes compared to open and/or laparoscopic techniques.

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References

  1. Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB (2003) Years of life lost due to obesity. JAMA 289:187–193

    Article  PubMed  Google Scholar 

  2. Flegal KM, Carroll MD, Ogden CL, Curtin LR (2010) Prevalence and trends in obesity among US adults, 1999–2008. JAMA 303:235–241

    Article  CAS  PubMed  Google Scholar 

  3. Anderson AS, Key TJ, Norat T et al (2015) European code against cancer 4th edition: obesity, body fatness and cancer. Cancer Epidemiol 39(Suppl 1):S34–S45

    Article  PubMed  Google Scholar 

  4. Burke WM, Gossner G, Goldman NA (2011) Robotic surgery in the obese gynecologic patient. Clin Obstet Gynecol 54:420–430

    Article  PubMed  Google Scholar 

  5. Almeida OD Jr (2013) Robotic hysterectomy strategies in the morbidly obese patient. JSLS 17:418–422

    Article  PubMed  PubMed Central  Google Scholar 

  6. Backes FJ, Rosen M, Liang M et al (2015) Robotic hysterectomy for endometrial cancer in obese patients with comorbidities: evaluating postoperative complications. Int J Gynecol Cancer 25:1271–1276

    Article  PubMed  Google Scholar 

  7. Bernardini MQ, Gien LT, Tipping H, Murphy J, Rosen BP (2012) Surgical outcome of robotic surgery in morbidly obese patient with endometrial cancer compared to laparotomy. Int J Gynecol Cancer 22:76–81

    Article  PubMed  Google Scholar 

  8. Bogliolo S, Mereu L, Cassani C et al (2015) Robotic single-site hysterectomy: two institutions’ preliminary experience. Int J Med Robot 11:159–165

    Article  PubMed  Google Scholar 

  9. Corrado G, Chiantera V, Fanfani F et al (2015) Robotic hysterectomy in severely obese patients with endometrial cancer: a multicenter study. J Minim Invasive Gynecol 23:94–100

    Article  PubMed  Google Scholar 

  10. Davenport WB, Lowe MP, Chamberlin DH et al (2013) Outcomes of obese versus non-obese subjects undergoing robotic-assisted hysterectomy: a multi-institutional study. J Robot Surg 7:15–20

    Article  CAS  PubMed  Google Scholar 

  11. Eddib A, Danakas A, Hughes S et al (2014) Influence of morbid obesity on surgical outcomes in robotic-assisted gynecologic surgery. J Gynecol Surg 30:81–86

    Article  PubMed  PubMed Central  Google Scholar 

  12. Gallo T, Kashani S, Patel DA, Elsahwi K, Silasi DA, Azodi M (2012) Robotic-assisted laparoscopic hysterectomy: outcomes in obese and morbidly obese patients. JSLS 16:421–427

    Article  PubMed  PubMed Central  Google Scholar 

  13. Gehrig PA, Cantrell LA, Shafer A, Abaid LN, Mendivil A, Boggess JF (2008) What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman? Gynecol Oncol 111:41–45

    Article  PubMed  Google Scholar 

  14. Geppert B, Lonnerfors C, Persson J (2011) Robot-assisted laparoscopic hysterectomy in obese and morbidly obese women: surgical technique and comparison with open surgery. Acta Obstet Gynecol Scand 90:1210–1217

    Article  PubMed  Google Scholar 

  15. Kannisto P, Harter P, Heitz F, Traut A, du Bois A, Kurzeder C (2014) Implementation of robot-assisted gynecologic surgery for patients with low and high BMI in a German gynecological cancer center. Arch Gynecol Obstet 290:143–148

    PubMed  Google Scholar 

  16. Menderes G, Azodi M, Clark L et al (2014) Impact of body mass index on surgical outcomes and analysis of disease recurrence for patients with endometrial cancer undergoing robotic-assisted staging. Int J Gynecol Cancer 24:1118–1125

    Article  PubMed  Google Scholar 

  17. Nawfal AK, Orady M, Eisenstein D, Wegienka G (2011) Effect of body mass index on robotic-assisted total laparoscopic hysterectomy. J Minim Invasive Gynecol 18:328–332

    Article  PubMed  Google Scholar 

  18. Nevadunsky N, Clark R, Ghosh S et al (2010) Comparison of robot-assisted total laparoscopic hysterectomy and total abdominal hysterectomy for treatment of endometrial cancer in obese and morbidly obese patients. J Robot Surg 4:247–252

    Article  Google Scholar 

  19. Rebeles SA, Muntz HG, Wieneke-Broghammer C et al (2009) Robot-assisted total laparoscopic hysterectomy in obese and morbidly obese women. J Robot Surg 3:141–147

    Article  Google Scholar 

  20. Stone P, Burnett A, Burton B, Roman J (2010) Overcoming extreme obesity with robotic surgery. Int J Med Robot 6:382–385

    Article  PubMed  Google Scholar 

  21. Mendivil AA, Rettenmaier MA, Abaid LN et al (2015) A comparison of open surgery, robotic-assisted surgery and conventional laparoscopic surgery in the treatment of morbidly obese endometrial cancer patients. JSLS 19(e2014):00001

    PubMed  Google Scholar 

  22. Seamon LG, Bryant SA, Rheaume PS et al (2009) Comprehensive surgical staging for endometrial cancer in obese patients: comparing robotics and laparotomy. Obstet Gynecol 114:16–21

    Article  PubMed  Google Scholar 

  23. Stephan JM, Goodheart MJ, McDonald M et al (2015) Robotic surgery in supermorbidly obese patients with endometrial cancer. Am J Obstet Gynecol 213(49):e1–e8

    PubMed  Google Scholar 

  24. Subramaniam A, Kim KH, Bryant SA et al (2011) A cohort study evaluating robotic versus laparotomy surgical outcomes of obese women with endometrial carcinoma. Gynecol Oncol 122:604–607

    Article  PubMed  Google Scholar 

  25. Tang KY, Gardiner SK, Gould C, Osmundsen B, Collins M, Winter WE 3rd (2012) Robotic surgical staging for obese patients with endometrial cancer. Am J Obstet Gynecol 206(513):e1–e6

    Article  PubMed  Google Scholar 

  26. Periodic health examination (1994) 1994 update: 1. Obesity in childhood. Canadian task force on the periodic health examination. CMAJ 150:871–879

    Google Scholar 

  27. Kaaks R, Lukanova A, Kurzer MS (2002) Obesity, endogenous hormones, and endometrial cancer risk: a synthetic review. Cancer Epidemiol Biomark Prev 11:1531–1543

    CAS  Google Scholar 

  28. Fader AN, Arriba LN, Frasure HE, von Gruenigen VE (2009) Endometrial cancer and obesity: epidemiology, biomarkers, prevention and survivorship. Gynecol Oncol 114:121–127

    Article  PubMed  Google Scholar 

  29. von Gruenigen VE, Gil KM, Frasure HE, Jenison EL, Hopkins MP (2005) The impact of obesity and age on quality of life in gynecologic surgery. Am J Obstet Gynecol 193:1369–1375

    Article  Google Scholar 

  30. Matias-Guiu X, Catasus L, Bussaglia E et al (2001) Molecular pathology of endometrial hyperplasia and carcinoma. Hum Pathol 32:569–577

    Article  CAS  PubMed  Google Scholar 

  31. Bogani G, Cromi A, Serati M et al (2015) Laparoscopic and vaginal approaches to hysterectomy in the obese. Eur J Obstet Gynecol Reprod Biol 189:85–90

    Article  PubMed  Google Scholar 

  32. Park JY, Kim DY, Kim JH, Kim YM, Kim YT, Nam JH (2012) Laparoscopic compared with open radical hysterectomy in obese women with early-stage cervical cancer. Obstet Gynecol 119:1201–1209

    Article  PubMed  Google Scholar 

  33. Benedetti Panici P, Basile S, Maneschi F et al (2008) Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 100:1707–1716

    Article  PubMed  Google Scholar 

  34. Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK (2009) Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 373:125–136

    Article  CAS  PubMed  Google Scholar 

  35. Seracchioli R, Solfrini S, Mabrouk M et al (2010) Controversies in surgical staging of endometrial cancer. Obstet Gynecol Int 2010:181963

    CAS  PubMed  PubMed Central  Google Scholar 

  36. POET trial. POET: prevention of endometrial tumours. http://www.controlled-trials.com/ISRCTN22037489. Accessed 03 Nov 2015

  37. Kyrgiou M, Swart AM, Qian W, Warwick J (2015) A comparison of outcomes following laparoscopic and open hysterectomy with or without lymphadenectomy for presumed early-stage endometrial cancer: results from the medical research council ASTEC trial. Int J Gynecol Cancer 25:1424–1436

    Article  PubMed  Google Scholar 

  38. Bige O, Demir A, Saatli B, Koyuncuoglu M, Saygili U (2015) Laparoscopy versus laparotomy for the management of endometrial carcinoma in morbidly obese patients: a prospective study. J Turk Ger Gynecol Assoc 16:164–169

    Article  PubMed  PubMed Central  Google Scholar 

  39. Colling KP, Glover JK, Statz CA, Geller MA, Beilman GJ (2015) Abdominal hysterectomy: reduced risk of surgical site infection associated with robotic and laparoscopic technique. Surg Infect (Larchmt) 16:498–503

    Article  Google Scholar 

  40. Blikkendaal MD, Schepers EM, van Zwet EW, Twijnstra AR, Jansen FW (2015) Hysterectomy in very obese and morbidly obese patients: a systematic review with cumulative analysis of comparative studies. Arch Gynecol Obstet 292:723–738

    Article  PubMed  PubMed Central  Google Scholar 

  41. Nezhat FR, Sirota I (2014) Perioperative outcomes of robotic assisted laparoscopic surgery versus conventional laparoscopy surgery for advanced-stage endometriosis. JSLS  18(4). pii: e2014.00094

  42. Chan JK, Gardner AB, Taylor K, Thompson CA, Blansit K, Yu X, Kapp DS (2015) Robotic versus laparoscopic versus open surgery in morbidly obese endometrial cancer patients—a comparative analysis of total charges and complication rates. Gynecol Oncol 139:300–305

    Article  PubMed  Google Scholar 

  43. Povolotskaya N, Woolas R, Brinkmann D (2015) Implementation of a robotic surgical program in gynaecological oncology and comparison with prior laparoscopic series. Int J Surg Oncol 2015:814315

    PubMed  PubMed Central  Google Scholar 

  44. Soliman PT, Langley G, Munsell MF, Vaniya HA, Frumovitz M, Ramirez PT (2013) Analgesic and antiemetic requirements after minimally invasive surgery for early cervical cancer: a comparison between laparoscopy and robotic surgery. Ann Surg Oncol 20:1355–1359

    Article  PubMed  PubMed Central  Google Scholar 

  45. Alenizi AM, Valdivieso R, Rajih E et al (2015) Factors predicting prolonged operative time for individual surgical steps of robot-assisted radical prostatectomy (RARP): a single surgeon’s experience. Can Urol Assoc J 9:E417–E422

    Article  PubMed  PubMed Central  Google Scholar 

  46. Iavazzo C, Gkegkes ID (2013) The role of uterine manipulators in endometrial cancer recurrence after laparoscopic or robotic procedures. Arch Gynecol Obstet 288:1003–1009

    Article  PubMed  Google Scholar 

  47. Iavazzo C, Mamais I, Gkegkes ID (2015) The role of knotless barbed suture in gynecologic surgery: systematic review and meta-analysis. Surg Innov 22:528–539

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Gynaecological Oncology Department, Christie Hospital, Manchester, UK

    Christos Iavazzo

  2. First Department of Surgery, General Hospital of Attica “KAT”, Athens, Greece

    Ioannis D. Gkegkes

  3. 38, Seizani Str., Nea Ionia, 14231, Athens, Greece

    Christos Iavazzo

Authors
  1. Christos Iavazzo
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  2. Ioannis D. Gkegkes
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Correspondence to Christos Iavazzo.

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Conflict of interest

The authors do not have any financial relationship/interest. Also, the authors have full control of all primary data and agree to allow the Journal to review their data if required.

Ethical statement

The manuscript does not contain patient data or animals studies.

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Iavazzo, C., Gkegkes, I.D. Robotic assisted hysterectomy in obese patients: a systematic review. Arch Gynecol Obstet 293, 1169–1183 (2016). https://doi.org/10.1007/s00404-016-4028-7

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