The Strategy of Robot-assisted Hysterectomy in Patients with Morbid Obesity.

Abstract

Robotic hysterectomy has emerged as a superior surgical approach for patients with obesity, providing significant benefits including reduced incidence of myocardial infarction, peripheral nerve injury, wound infections, and urinary tract infections. However, these unique considerations require careful attention when managing such cases. Therefore, this study aimed to propose several key strategies for achieving optimal outcomes, including maintaining a mild Trendelenburg position (12°), ensuring the patient's secure positioning, avoiding the lithotomy position, considering a slightly higher pneumoperitoneum insufflation pressure (12 mmHg), and using a 30° endoscope for improved visualization rather than a 0° endoscope. We present three cases of stage IA atypical endometrial hyperplasia and carcinoma. All three patients underwent robotic hysterectomy and bilateral salpingo-oophorectomy, with body mass indices of 53.3, 43.8, and 43.7 kg/m².