Robotic single-port versus multi-port surgical staging in obese patients with early-stage endometrial cancer

To assess the feasibility of robotic single-port (SP) surgical staging in obese patients with apparent early-stage endometrial cancer.

This retrospective comparative study included obese patients, defined as those with a body mass index ≥30 kg/m², undergoing robotic-assisted surgical staging. Outcomes of patients undergoing SP robotic surgery were compared with those of a BMI-distributionally matched comparison cohort undergoing surgical staging with a multi-port (MP) robotic system.

Charts of consecutive 415 endometrial cancer patients were retrieved. Over the study period, 110 and 305 had surgery with SP and MP platform, respectively. Obese patients having SP surgery (n = 38) were BMI-distributionally matched 1:1 with 38 controls selected from the MP group. The SP robotic completion rate was 97.4% (37/38), with one patient requiring conversion to conventional laparoscopy. Baseline patient characteristics are similar between groups except for tumor grade. Median (range) BMI was 34.7 (30.1 - 47.6) and 34.8 (30 - 47.7) kg/m², respectively (p = 0.962). Median operative time was significantly longer in the SP group (120 vs. 100 min; p = 0.0033), while estimated blood loss was comparable. Length of hospital stay was significantly longer in the SP group (3.5 vs. 3.0 days; p = 0.0006), although this difference was influenced only by one case. Increasing BMI was not associated with longer operative time in either group. No intraoperative complications or severe postoperative events were recorded.

This preliminary experience supports the feasibility of SP robotic staging in selected obese patients, while larger studies are needed to assess comparative safety and perioperative outcomes.