Obesity has become a serious and rapidly rising condition in the nation. It causes various health conditions, including hypertension, adverse lipid concentrations, and type 2 diabetes. More specifically, obesity has a profound impact on gynecologic patients, is associated with greater risk of ovulatory dysfunction, pelvic-organ prolapse, and has also been shown to cause an increased risk of endometrial polyps, symptomatic fibroids, endometrial hyperplasia, endometrial cancer, and breast cancer.

Obesity is associated with poorer surgical outcomes, especially after procedures of increased technical complexity. They are more likely to present with other medical conditions, particularly cardiac and respiratory diseases. There is clear evidence that obesity is a risk factor for developing gynecologic cancers, mainly endometrial cancer.

Minimally invasive surgical methods are becoming more common for treating endometrial cancer. In obese patients, peritoneal-cavity access may be more difficult, and there is suboptimal peritoneal distension, and reduced vision and operating freedom for the surgeon.

The introduction of the robotic system has helped to overcome the technical limitations of laparoscopy by simplifying the procedures. Evidences are suggestive that robotic surgery is associated with improved lymph-node count, reduced blood loss, shorter operative times, and diminished hospital stays, compared to laparoscopic and open surgeries. It is also associated with decrease in operative time, hospital stay, estimated blood loss, and complications when comparing laparoscopic surgery for endometrial cancer staging to robotic surgery.

Benefit of robotic surgery

Today we operated on a very tough case. It was one of the toughest case to operate.

A lady weighing 126 kg with BMI of 46.5 with previous 2 caesarean sections, diabetes, hypertension, obstructive sleep apnoea with early endometrial cancer. The surgery went well and the patient is doing well.

The entire surgery, hysterectomy + pelvic lymph node dissection was possible because of the excellent technological benefits that the Robotic platform offers and our excellent team of anaesthesiologists, residents, OT staff, nursing, technicians. Full credit to our anaesthesiology team for managing such a complicated case.

Patient was sitting comfortably with minimal pain by evening and was started orally.

This type of recovery is not possible in open surgery Even in laparoscopic surgery, we would have had to convert it into a open procedure as there were lot of challenges –

• Steep trendlenbourg (head low position),

• Difficulty in visualising surgical field due to small and large bowel, bladder

• Inability to inflate the abdomen at higher pressure

It’s the expertise of our anaesthesiologists which needs to be highlighted and appreciated We have done close to 50 cases with morbid obesity (BMI >40-42)
We are one of the few centres in India who is doing Robotic assisted surgeries in patients with Gyneconcological Cancers with morbid obesity BMI > 40