Bruni Simone, Bogani Giorgio, Antonaci Alessandra, Fernandez-Gonzalez Sergi, Nobbenhuis Marielle, Iavazzo Christos, Ceppi Lorenzo, Leone Roberti Maggiore Umberto, Schivardi Gabriella, Vizza Enrico, Maggioni Angelo, Zanagnolo Vanna
Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133, Milan, Italy.
Department of Gynecology, European Institute of Oncology (IEO) IRCCS, Milan, Italy.
J Robot Surg. 2025 Sep 5;19(1):562. doi: 10.1007/s11701-025-02744-0.
Obesity is closely linked to an increased incidence of several gynecological conditions and poses significant challenges to their surgical management. Among these, endometrial cancer stands out due to its high prevalence in patients with elevated body mass index, with nearly 60% of those requiring primary surgical treatment classified as obese or morbidly obese. The coexistence of multiple comorbidities in this population contributes to a heightened risk of perioperative and postoperative complications. Robotic-assisted surgery has emerged as a key advancement in minimally invasive gynecologic procedures, offering meaningful clinical advantages over conventional laparoscopy. These include decreased intraoperative blood loss, reduced complication rates, and shorter recovery times. Such benefits are particularly advantageous in obese patients, where robotic techniques are associated with significantly lower rates of conversion to laparotomy. Nonetheless, the surgical care of these patients remains complex and requires the coordinated expertise of seasoned surgical and anesthetic teams. The aim of this review is to provide evidence-based tips and techniques for performing successful minimally invasive robotic-assisted procedures in obese patients. This paper will review current evidence on: (1) operating room setup and patient preparation; (2) robotic port placement strategies; (3) pneumoperitoneum establishment and physiological considerations; (4) intraoperative techniques and (5) practical solutions for addressing challenges in retroperitoneal staging.
肥胖与多种妇科疾病的发病率增加密切相关，并对其手术治疗构成重大挑战。其中，子宫内膜癌因其在体重指数升高的患者中患病率高而突出，近60% 需要接受初次手术治疗的患者被归类为肥胖或病态肥胖。该人群中多种合并症的共存导致围手术期和术后并发症的风险增加。机器人辅助手术已成为微创妇科手术的一项关键进展，与传统腹腔镜手术相比具有显著的临床优势。这些优势包括术中出血量减少、并发症发生率降低和恢复时间缩短。这些益处对于肥胖患者尤为有利，因为机器人技术与开腹手术的转换率显著降低相关。尽管如此，这些患者的手术护理仍然复杂，需要经验丰富的手术和麻醉团队的协同专业知识。本综述的目的是为肥胖患者成功实施微创机器人辅助手术提供循证技巧和技术。本文将综述以下方面的现有证据：（1）手术室设置和患者准备；（2）机器人端口放置策略；（3）气腹建立和生理考虑因素；（4）术中技术；（5）解决腹膜后分期挑战的实用解决方案。
