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Challenges of Robotic Gynecologic Surgery in Morbidly Obese Patients and How to Optimize Success

  • Other Pain (A Kaye and N Vadivelu, Section Editors)
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Abstract

Purpose of Review

Robotic surgery has been shown to have a significant benefit in obese gynecologic patients over open surgery. However, robotic surgery in these patients requires a thorough understanding of the physiologic adaptations caused by obesity, adequate preoperative optimization, specialized equipment and techniques, and careful attention to intra- and postoperative management in order to minimize complications. This article reviews the benefits of a minimally invasive approach in obese patients and provides a thorough guide to perioperative management of obese patients undergoing robotic gynecologic surgery. A useful set of tips and tricks to overcome many of the technical challenges in performing robotic surgery in the obese patients is included.

Recent Findings

In the USA, obesity has risen to affect 39.8% of the population, which leads to increased incidence of mortality, hypertension, diabetes, heart disease, and stroke. Moreover, obese patients are at greater risk of perioperative complications during gynecologic surgery. With the use of laparoscopy, many of the perioperative risks of surgery in obese patients can be ameliorated. However, minimally invasive surgery in obese patients is technically challenging. Robotic-assisted laparoscopy addresses several of these challenges, allowing surgeons to offer minimally invasive approaches to patients with extreme BMIs while reducing perioperative risk.

Summary

Obese patients undergoing gynecologic surgery receive a greater benefit than their non-obese counterparts from a laparoscopic approach, and current data support the safety and feasibility of robotic surgery in the obese population. Therefore, every effort to offer a minimally invasive surgery to obese patients should be made.

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Authors and Affiliations

  1. Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, Yale University School of Medicine, PO Box 208063, New Haven, CT, 06520-806, USA

    Gulden Menderes, Stefan M. Gysler & Dan-Arin Silasi

  2. Department of Anesthesiology, Yale University School of Medicine, PO Box 20805, New Haven, CT, 06520-8051, USA

    Nalini Vadivelu

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  1. Gulden Menderes
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  2. Stefan M. Gysler
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  3. Nalini Vadivelu
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  4. Dan-Arin Silasi
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Correspondence to Gulden Menderes.

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Menderes, G., Gysler, S.M., Vadivelu, N. et al. Challenges of Robotic Gynecologic Surgery in Morbidly Obese Patients and How to Optimize Success. Curr Pain Headache Rep 23, 51 (2019). https://doi.org/10.1007/s11916-019-0788-7

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