Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Int J Gynecol Cancer. 2011 May;21(4):722-9. doi: 10.1097/IGC.0b013e318212981d.
This is a prospective evaluation of the outcome of minimal invasive surgery using robotics in function of the body mass index (BMI) of patients.
This is a prospective cohort study of consecutive women undergoing surgery for endometrial cancer at a tertiary care facility since the initiation of a robotic program in December 2007. Surgical and personal outcome variables as well as quality of life and postoperative recovery were assessed using a combination of objective and subjective/self-report questionnaires. Women were divided into 3 groups based on their BMI. Comparative analyses among nonobese (n = 52), obese (n = 33) and morbidly obese (n = 23) women were performed on the outcome measures after surgery.
The mean BMI and the range in each of the BMI categories was 25 kg/m² (18.7-29.4 kg/m²), 34 kg/m² (30.1-38.4 kg/m²), and 46 kg/m² (40.0-58.8 kg/m²). Women with higher BMI tended to be more frequently affected with comorbidities such as diabetes (15.4%, 26.0%, and 27.3%, respectively; P = 0.32) and hypertension (55.8%, 69.6%, and 69.7%, respectively; P = 0.19). Despite these differences, surgical console time (P = 0.20), major postoperative complications (P = 0.52), overall wound complications (P = 0.18), and median length of hospitalization in days (P = 0.17) were not statistically different among the 3 groups. Only 5.6% of women needed a mini laparotomy all of which were performed for the removal of their enlarged uterus, which could not be delivered safely via the vagina, at the end of the surgical procedure. There was no increased conversion to laparotomy due to increased BMI. Women in all 3 groups reported rapid resumption of hygiene regimens and chores, little need for narcotic analgesia, and high satisfaction with the procedure.
Obese and morbidly obese patients with endometrial cancer are also good candidates for robotic surgery. These women benefit considerably from minimal invasive surgery and have little perioperative complications.
本研究旨在评估肥胖患者接受机器人微创手术的效果，该研究为前瞻性评估，纳入了自 2007 年 12 月开展机器人手术项目以来，在三级医疗机构接受手术治疗的子宫内膜癌患者。通过使用客观和主观/自我报告问卷，评估了手术和个人结局变量以及生活质量和术后恢复情况。根据 BMI 将患者分为 3 组，比较非肥胖（n=52）、肥胖（n=33）和病态肥胖（n=23）患者的术后结局指标。
本研究为连续女性患者的前瞻性队列研究，这些患者均在一家三级医疗机构接受了子宫内膜癌手术治疗，且该机构于 2007 年 12 月开始开展机器人手术项目。采用客观和主观/自我报告问卷，评估了手术和个人结局变量，以及生活质量和术后恢复情况。根据 BMI 将患者分为 3 组。比较非肥胖（n=52）、肥胖（n=33）和病态肥胖（n=23）患者的术后结局指标。
BMI 均值和 BMI 分类的范围分别为 25 kg/m²（18.7-29.4 kg/m²）、34 kg/m²（30.1-38.4 kg/m²）和 46 kg/m²（40.0-58.8 kg/m²）。BMI 较高的女性更常患有合并症，如糖尿病（15.4%、26.0%和 27.3%，P=0.32）和高血压（55.8%、69.6%和 69.7%，P=0.19）。尽管存在这些差异，但手术控制台时间（P=0.20）、主要术后并发症（P=0.52）、总伤口并发症（P=0.18）和中位住院天数（P=0.17）在 3 组间无统计学差异。只有 5.6%的女性需要小剖腹手术，所有这些手术都是为了在手术结束时取出无法经阴道安全分娩的增大子宫。BMI 增加并没有导致更多的转为剖腹手术。所有 3 组的女性均报告快速恢复卫生习惯和家务，很少需要使用麻醉性镇痛药，对手术过程非常满意。
肥胖和病态肥胖的子宫内膜癌患者也是机器人手术的良好候选者。这些女性从微创手术中获益匪浅，围手术期并发症很少。
