Robotic Hysterectomy for Endometrial Cancer in Class III Obesity: 13 Years of Experience From a UK Epicentre in...

Surgery in morbidly obese patients is technically challenging; however, this can be mitigated using robotic surgery. We present 13-years' experience of robotic hysterectomy in patients with Class-III obesity (BMI≥ 40 kg/m) and endometrial cancer.

This retrospective cohort study included 236 women with Class-III obesity who underwent robotic hysterectomy for endometrial cancer between 2010 and 2023. Key outcomes include, completion rates and peri-operative events. Comparative analysis evaluated outcomes following technological upgrades, introduction of sentinel lymph-node assessment and surgeons' learning curve. Statistical analysis used Fisher's exact test and Chi-squared for categorical variables, and ANOVA and Kruskall-Wallis tests for continuous variables.

Robotic hysterectomy was completed in 91.5% (216/236), with conversion to laparotomy in 2.5% (6/236). Median inpatient admission was 1 day. Infection occurred in 6.9% (15/216). A statistically significant decrease in laparotomies from 11% (9/236) (2010-2015) to 0% (2020-2023) (p = 0.004) was observed.

Robotic Hysterectomy can be safely completed in majority of morbidly obese patients with endometrial cancer with minimal perioperative complications.