Robotic-assisted surgery in extremely obese patients: a multidisciplinary approach for a patient with a BMI of 101.7 kg/m2.

Abstract

Background: The prevalence of obesity has risen significantly, affecting over 19% of the German population. Obesity is frequently associated with endometrial cancer, presenting considerable challenges in pre-, intra- and postoperative management. Challenges with intubation, patient positioning, respiratory and cardiac complications as well as wound dehiscence are commonly encountered in this patient population.

Methods and results: For patients with uterine cancer, surgical intervention is essential for staging, symptom control, and potential cure. Minimally invasive approaches, particularly robotic-assisted surgery, have expanded the possibilities for treating morbidly obese patients. Robotic systems facilitate navigation around anatomical barriers and reduce surgeon fatigue. However, despite the technological advancements, morbidly obese patients often face increased perioperative risks and prolonged postoperative recovery. Laparoscopic procedures in steep Trendelenburg position for morbidly obese patients pose unique challenges, particularly in anesthesiological management. These challenges necessitate individualized ventilatory and hemodynamic support to ensure patient safety. This case highlights a multidisciplinary approach to managing a patient with extreme obesity (BMI 101.7 kg/m²) undergoing roboticassisted surgery for uterine cancer. It underscores the importance of comprehensive preoperative planning, intra-operative considerations, and post-operative care in minimizing complications and optimizing outcomes.

Conclusion: Our case exemplifies our experience from similar cases and demonstrates that robotic-assisted surgery for endometrial cancer in obese patients can represent a safe and feasible option, characterized by a low complication rate, minimal blood loss, and a short hospital stay.