D. Eisenstein

Effect of Body Mass Index on Robotic-Assisted Total Laparoscopic Hysterectomy

STUDY OBJECTIVE To estimate the impact of body mass index (BMI) on the surgical outcomes of patients undergoing robotic-assisted total laparoscopic hysterectomy. DESIGN Retrospective cohort study. SETTING Henry Ford Health System academic medical center (Henry Ford and Henry Ford West Bloomfield Hospitals) PATIENTS A total of 135 patients who underwent scheduled robotic-assisted total laparoscopic hysterectomy for benign indications, without concomitant urogynecologic procedures between January 2008 and June 2010. INTERVENTIONS Patients underwent robotic-assisted total laparoscopic hysterectomy as the intention to treat. Two cases were converted to laparotomy. MEASUREMENTS & MAIN RESULTS: Electronic medical records of all patients that underwent robotic-assisted total laparoscopic hysterectomy at Henry Ford Health System were reviewed. Data on demographics, BMI (kg/m(2)), estimated blood loss, perioperative hemoglobin change, procedure duration, hospital length of stay, specimen weight, pathology, and postoperative complications were obtained. The womens median age was 45 years (range 30-68), 61.5% were black, and BMI ranged from 14.8-56.2 kg/m2; 23.4% of women were normal weight or less (BMI <25, n = 31), 52.7% of women were obese (BMI >30, n = 70) and 36 of these patients (27.1%) were morbidly obese (BMI ≥35). BMI did not correlate with procedure duration (Spearman r = .12, p = .16), length of stay (Spearman r = .10, p = .24), or estimated blood loss (Spearman r = .12, p =.18). Our analysis did not identify any meaningful associations between BMI and absolute change in hemoglobin. In addition BMI was not associated with an increase in major or minor complications. CONCLUSION BMI is not associated with blood loss, duration of surgery, length of stay, or complication rates in patients undergoing robotic-assisted total laparoscopic hysterectomy. Robotic assistance may help surgeons overcome adverse outcomes sometimes found in obese patients.

Analysis of the Impact of Body Mass Index on the Surgical Outcomes after Robot-Assisted Laparoscopic Myomectomy

STUDY OBJECTIVE To estimate the impact of body mass index (BMI) on surgical outcomes in patients undergoing robotic myomectomy. DESIGN A retrospective cohort data analysis (Canadian Task Force classification II-2). SETTING Community-based teaching hospital. PATIENTS A total of 77 consecutive patients from January 2005 through November 2008 with symptomatic leiomyomata. INTERVENTION Robotic-assisted laparoscopic myomectomy. MEASUREMENTS AND MAIN RESULTS Body mass index ([BMI] expressed as kg/m(2)) was abstracted from the medical charts of all patients undergoing robotic myomectomy. Data on estimated blood loss, procedure time, length of hospital stay, diameter of the largest fibroid, and specimen weight were also extracted. Overall patient demographics between the groups were similar. Thirty-two patients (41.6%) were obese or morbidly obese (BMI>30). The parameters analyzed for associations with the continuous measure of BMI included length of postoperative hospital stay (LOS), estimated blood loss (EBL), and procedure duration. Median (range) procedure time among all patients was (195 minutes, 98-653 minutes), estimated blood loss was (100 mL, 10-700 mL), and length of hospital stay was (1 day, 1-5 days). No associations were determined between BMI and LOS (r=0.14, p=.22), EBL (r=0.25, p=.03), or procedure duration (r=0.16, p=.22) with Spearman correlations. The size of the largest leiomyoma diameter did not affect these associations. CONCLUSION Preoperative obesity is not a risk factor for poor surgical outcome in patients undergoing robotic myomectomy.