Abstract
Study Objective: To analyze the impact of body mass index (BMI) on the surgical outcomes of patients undergoing Robotic-assisted total laparoscopic hysterectomy (RH). Design: Retrospective cohort study. Setting: Henry Ford Health System's (HFHS) community-based teaching hospitals. Patients: 120 patients who underwent scheduled RH for benign indications, without concomitant urogynecologic procedures, between January 2008 and March 2010. Intervention: Patients underwent RH as the intention to treat. 2 cases were converted to laparotomy. Measurements and Main Results: Electronic medical records of all patients that underwent RH at HFHS were reviewed. Data on demographics, BMI (kg/m2), estimated blood loss (EBL), peri-operative hemoglobin change, procedure duration, hospital length of stay (LOS), specimen weight, pathology and post operative complications were obtained. The women's average age was 45.2 years (SD=6.9 years), the majority were Black (60%), and BMI ranged from 14.8-56.2. Only 23% were of normal weight or less (BMI <25, n=27) with 53.4% of women being at least obese (BMI>30, n=64); 32, of these patients (26.7%) were morbidly obese (BMI>=35). Overall, BMI was not correlated with procedure duration or LOS (Spearman correlations r=.12 (p=.19), and r=.10 (p=.28) respectively). BMI was not associated with EBL (Spearman correlations r=.11 (p=.23)), and the assessment of peri-operative drop in Hemoglobin showed an inverse relationship, if any, to BMI (r=.29, p=.002), but the extent of difference showing a very small difference in median decrease in hemoglobin between normal weight (median -2.2 g/dL) and morbidly obese patients (median -1.1 g/dL). BMI was not associated with an increase in major or minor complications. Conclusion: BMI is not associated with adverse outcomes in patients undergoing Robotic-assisted total laparoscopic hysterectomy. There was no association with increased blood loss, duration of surgery, length of stay, or increase in complications. Robotic assistance may overcome adverse surgical outcomes associated with obesity.
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