Csorba Roland, Almasarweh Sàed, Elfrink Zeynep Atas, Buderath Paul, Kimmig Rainer, Britten Martin W
Department of Obstetrics and Gynaecology, University Clinic Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
Department of Anaesthesiology and Intensive Medicine, University Clinic Essen, University of Duisburg-Essen, Essen, Germany.
Arch Gynecol Obstet. 2025 Aug 26. doi: 10.1007/s00404-025-08158-5.
The prevalence of obesity has risen significantly, affecting over 19% of the German population. Obesity is frequently associated with endometrial cancer, presenting considerable challenges in pre-, intra- and postoperative management. Challenges with intubation, patient positioning, respiratory and cardiac complications as well as wound dehiscence are commonly encountered in this patient population.
For patients with uterine cancer, surgical intervention is essential for staging, symptom control, and potential cure. Minimally invasive approaches, particularly robotic-assisted surgery, have expanded the possibilities for treating morbidly obese patients. Robotic systems facilitate navigation around anatomical barriers and reduce surgeon fatigue. However, despite the technological advancements, morbidly obese patients often face increased perioperative risks and prolonged postoperative recovery. Laparoscopic procedures in steep Trendelenburg position for morbidly obese patients pose unique challenges, particularly in anesthesiological management. These challenges necessitate individualized ventilatory and hemodynamic support to ensure patient safety. This case highlights a multidisciplinary approach to managing a patient with extreme obesity (BMI 101.7 kg/m) undergoing roboticassisted surgery for uterine cancer. It underscores the importance of comprehensive preoperative planning, intra-operative considerations, and post-operative care in minimizing complications and optimizing outcomes.
Our case exemplifies our experience from similar cases and demonstrates that robotic-assisted surgery for endometrial cancer in obese patients can represent a safe and feasible option, characterized by a low complication rate, minimal blood loss, and a short hospital stay.
肥胖症的患病率显著上升，影响了超过19%的德国人口。肥胖症常与子宫内膜癌相关，在术前、术中和术后管理中带来了相当大的挑战。这类患者群体常见插管、患者体位摆放、呼吸和心脏并发症以及伤口裂开等问题。
对于子宫癌患者，手术干预对于分期、症状控制和潜在治愈至关重要。微创方法，尤其是机器人辅助手术，扩大了治疗病态肥胖患者的可能性。机器人系统便于在解剖屏障周围导航并减轻外科医生的疲劳。然而，尽管有技术进步，病态肥胖患者往往面临更高的围手术期风险和更长的术后恢复时间。为病态肥胖患者采用陡峭头低脚高位的腹腔镜手术带来了独特的挑战，尤其是在麻醉管理方面。这些挑战需要个性化的通气和血流动力学支持以确保患者安全。本病例突出了一种多学科方法，用于管理一名极度肥胖（BMI 101.7 kg/m²）的患者，该患者接受机器人辅助子宫癌手术。它强调了全面的术前规划、术中考虑和术后护理在最小化并发症和优化治疗结果方面的重要性。
我们的病例例证了我们从类似病例中获得的经验，并表明肥胖患者的机器人辅助子宫内膜癌手术可以是一种安全可行的选择，其特点是并发症发生率低、失血少且住院时间短。
