Damiani Gianluca R, Villa Mario, Di Naro Edoardo, Signorelli Mauro, Corso Silvia, Trojano Giuseppe, Loverro Matteo, Capursi Teresa, Muzzupapa Giuseppe, Pellegrino Antonio
Department of Biomedical Sciences and Human Oncology, Clinic of Gynecologic and Obstetrics, University of Bari, Bari, Italy -
Department of Obstetrics and Gynecology, ASTT Lecco, Alessandro Manzoni Hospital, Lecco, Italy.
Minerva Ginecol. 2019 Dec;71(6):412-418. doi: 10.23736/S0026-4784.19.04440-X.
Advanced laparoscopic procedures have been shown to be safe in patients with high Body Mass Index (BMI), but conversion rates remain high. This analysis aimed to evaluate the feasibility and clinical outcomes in terms of long- and short-term complications, pain relief of robotic surgery in morbidly obese patients.
Patients with BMI class I-II-III with endometrial cancer or hyperplasia were treated with robotic hysterectomy (RH). Patients' characteristics, operating room time (OT), type of surgery, length of hospital stay, and incidence of complications were recorded. Records were reviewed for demographic data, medical/surgical history and comorbidities, perioperative findings and outcomes, as well as long-term complications and recurrences. Regarding stage, according to 2009 FIGO, 26 of cases were IA, while eight and five of cases were, respectively, IB, II stage.
A total of 87 consecutive RH were analyzed. The more frequent comorbidity was hypertension. Twenty percent of the patients had multiple comorbidities (>2). The mean age was 63±10 years, with a mean BMI of 36±8.2 kg/m2. The more frequent BMI group treated was II class. The median OT was 114 minutes (range: 49-270). According to the Dindo Classification, there were no differences in major or minor complications between the 3 BMI classes. This series had a median follow-up of 60 months (range: 8-96) with an overall survival rate of 100%. The RRH+PLH was feasible and pathology confirmed the adequacy of the surgical specimen, with a median count of 20 nodes.
Our data support the adoption of the surgical management of the morbidly obese patient. Although short term complication rates are higher with increasing obesity (II-III class), a majority of procedures can still be completed with minimally invasive approach.
高级腹腔镜手术已被证明在高体重指数（BMI）患者中是安全的，但中转开腹率仍然很高。本分析旨在评估机器人手术在病态肥胖患者中的可行性以及长期和短期并发症、疼痛缓解方面的临床结局。
对BMI为I-II-III级的子宫内膜癌或增生患者进行机器人子宫切除术（RH）。记录患者的特征、手术时间（OT）、手术类型、住院时间和并发症发生率。回顾记录以获取人口统计学数据、医疗/手术史和合并症、围手术期发现和结局以及长期并发症和复发情况。关于分期，根据2009年国际妇产科联盟（FIGO）标准，26例为IA期，8例和5例分别为IB期、II期。
共分析了87例连续的RH手术。最常见的合并症是高血压。20%的患者有多种合并症（>2种）。平均年龄为63±10岁，平均BMI为36±8.2kg/m²。治疗的BMI组中最常见的是II级。中位手术时间为114分钟（范围：49-270分钟）。根据丁多分类法，3个BMI等级之间在主要或次要并发症方面没有差异。本系列的中位随访时间为60个月（范围：8-96个月），总生存率为100%。RRH+PLH是可行的，病理证实手术标本足够，中位淋巴结计数为20个。
我们的数据支持对病态肥胖患者采用手术治疗。尽管随着肥胖程度增加（II-III级）短期并发症发生率更高，但大多数手术仍可通过微创方法完成。
