Annals of Surgical Oncology

, Volume 23, Issue 7, pp 2192–2198 | Cite as

Impact of Robotic Platforms on Surgical Approach and Costs in the Management of Morbidly Obese Patients with Newly Diagnosed Uterine Cancer

  • Mario M. Leitao
  • Wazim R. Narain
  • Donna Boccamazzo
  • Vasileios Sioulas
  • Danielle Cassella
  • Jennifer A. Ducie
  • Ane Gerda Z. Eriksson
  • Yukio Sonoda
  • Dennis S. Chi
  • Carol L. Brown
  • Douglas A. Levine
  • Elizabeth L. Jewell
  • Oliver Zivanovic
  • Richard R. Barakat
  • Nadeem R. Abu-Rustum
  • Ginger J. Gardner
Gynecologic Oncology

Abstract

Background

Minimally invasive surgery (MIS) is associated with decreased complication rates, length of hospital stay, and cost compared with laparotomy. Robotic-assisted surgery—a method of laparoscopy—addresses many of the limitations of standard laparoscopic instrumentation, thus leading to increased rates of MIS. We sought to assess the impact of robotics on the rates and costs of surgical approaches in morbidly obese patients with uterine cancer.

Methods

Patients who underwent primary surgery at our institution for uterine cancer from 1993 to 2012 with a BMI ≥40 mg/m2 were identified. Surgical approaches were categorized as laparotomy (planned or converted), laparoscopic, robotic, or vaginal. We identified two time periods based on the evolving use of MIS at our institution: laparoscopic (1993–2007) and robotic (2008–2012). Direct costs were analyzed for cases performed from 2009 to 2012.

Results

We identified 426 eligible cases; 299 performed via laparotomy, 125 via MIS, and 2 via a vaginal approach. The rates of MIS for the laparoscopic and robotic time periods were 6 % and 57 %, respectively. The rate of MIS was 78 % in this morbidly obese cohort in 2012; 69 % were completed robotically. The median length of hospital stay was 5 days (range 2–37) for laparotomy cases and 1 day (range 0–7) for MIS cases (P < 0.001). The complication rate was 36 and 15 %, respectively (P < 0.001). The rate of wound-related complications was 27 and 6 %, respectively (P < 0.001). Laparotomy was associated with the highest cost.

Conclusions

The robotic platform provides significant health and cost benefits by increasing MIS rates in this patient population.

Keywords

Obese Patient Uterine Cancer Sentinel Lymph Node Mapping Robotic Platform Laparoscopic Case 

Notes

Acknowledgment

Funded in part by the cancer center core Grant P30 CA008748.

Conflicts of interest

The authors have no conflicts of interest or funding to disclose.

Supplementary material

10434_2015_5062_MOESM1_ESM.docx (48 kb)
Supplementary material 1 (DOCX 48 kb)

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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Mario M. Leitao
    • 1
    • 2
  • Wazim R. Narain
    • 1
  • Donna Boccamazzo
    • 1
  • Vasileios Sioulas
    • 1
  • Danielle Cassella
    • 1
  • Jennifer A. Ducie
    • 1
  • Ane Gerda Z. Eriksson
    • 1
  • Yukio Sonoda
    • 1
    • 2
  • Dennis S. Chi
    • 1
    • 2
  • Carol L. Brown
    • 1
    • 2
  • Douglas A. Levine
    • 1
    • 2
  • Elizabeth L. Jewell
    • 1
    • 2
  • Oliver Zivanovic
    • 1
    • 2
  • Richard R. Barakat
    • 1
    • 2
  • Nadeem R. Abu-Rustum
    • 1
    • 2
  • Ginger J. Gardner
    • 1
    • 2
  1. 1.Gynecology Service, Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Department of Obstetrics and GynecologyWeill Cornell Medical CollegeNew YorkUSA

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