Robotic Hysterectomy Strategies in the Morbidly Obese Patient

BACKGROUND AND OBJECTIVES: The purpose of this study was to present strategies for performing computer-enhanced telesurgery in the morbidly obese patient. METHODS: This was a prospective, institutional review board-approved, descriptive feasibility study (Canadian Task Force classification II-2) conducted at a university-affiliated hospital. Twelve class III morbidly obese women with a body mass index of 40 kg/m(2) or greater were selected to undergo robotic-assisted total laparoscopic hysterectomy. Robotic-assisted total laparoscopic hysterectomy, classified as type IVE, with complete detachment of the cardinal-uterosacral ligament complex, unilateral or bilateral, with entry into the vagina was performed. RESULTS: The median estimated blood loss was 146.3 mL (range, 15–550 mL), the mean length of stay in the hospital was 25.3 hours (range, 23–48 hours), and the complication rate was 0%. The rate of conversion to laparotomy was 8%. The median surgical time was 109.6 minutes (range, 99–145 minutes). CONCLUSION: Robotic-assisted total laparoscopic hysterectomy can be a safe and effective method of performing hysterectomies in select morbidly obese patients, allowing them the opportunity to undergo minimally invasive surgery without increased perioperative complications.