Abstract
<h3>Study Objective</h3> Compare the surgical outcomes of robotic versus laparoscopic surgery in the treatment of endometrial cancer for morbidly obese patients. <h3>Design</h3> A cohort of morbidly obese patients who underwent robotic assisted hysterectomy with lymphadenectomy (RHLND) was compared to a historical cohort of patients who underwent laparoscopic hysterectomy with lymphadenectomy (LHLND) for the treatment of endometrial cancer. The estimated blood loss (EBL), average operative times (AOT), intraoperative and postoperative outcomes, number of pelvic (PLN) and paraaortic (PALN) lymph nodes retrieved, and number of conversions to open laparotomy were evaluated. <h3>Setting</h3> A tertiary hospital. <h3>Patients or Participants</h3> From 1999 to 2018, all patients with BMI >30 who underwent RHLND or LHLND. <h3>Interventions</h3> The surgical outcomes measured were EBL, operative times, intraoperative and postoperative complications, number of PLN and PALN retrieved, and rate of conversion to open laparotomy. Fisher exact tests or two tailed t-tests were used to analyze for difference. <h3>Measurements and Main Results</h3> 330 patients underwent surgical treatment for endometrial cancer between 1999-2018. 254 (77%) patients were RHLND and 76 (23%) patients were LHLND. The mean age and BMI were comparable. The AOT (123 minutes) and EBL (50cc) for RHLND was significantly less compared to AOT (169 minutes) and EBL (198cc) for LHND. The average number of pelvic lymph nodes in RHLND (18) and aortic lymph nodes (9) retrieved were significantly less than LHLND pelvic lymph nodes (24) and aortic lymph nodes (17). The rate of conversion to open procedures favor the RHLND group 0/254 (0%) compared to the LHLND 7/76 (9.2%). No significant difference for intraoperative RHLND 5/254 (2%) vs LHLND 2/76 (3%) and postoperative RHLND 17/254 (7%) vs LHLND 4/76 (5%) complication rate was noted. <h3>Conclusion</h3> The surgical outcomes for treatment of endometrial cancer in obese patients with RHLND compared to LHLND is associated with less blood, shorter operative time, less conversion to open with no difference in postoperative complication rate.
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