肥満症例におけるロボット支援下手術は安全か

抄録

　To evaluate the safety and usefulness of robot-assisted surgery for obese patients, 172 patients who received robot-assisted total hysterectomy for benign and malignant uterine diseases at our hospital from September 2019 to March 2023 were enrolled in this study. The patients were divided into two groups: obesity and non-obesity. The obesity group was classified as those with body mass index (BMI) of 30 or more. We retrospectively examined the preparation time and that of the console setup, console time, total operation time from the start of surgery, blood loss, and frequency of perioperative complications.

　There were 27 patients in the obesity group and 145 in the non-obesity group. The median BMI was 34.4 (30.5-51.1) and 21.9 (15.5-29.7) for the obesity and non-obesity groups, respectively. There were no significant differences in patients' characteristics between the groups. The median preparation time was 20 (12-37) and 18 (7-60) min in the obesity and non-obesity groups, respectively. Total operative time and console time also did not differ significantly. The median blood loss was 10 (0-300) ml in the obese group and 10 (0-450) ml in the non-obese group, with no statistical difference. In comparisons to cases with malignant uterine diseases or benign uterine diseases, no significant difference was observed. There was also no difference in the weight of the excised uteruses. Complications of Clavien-Dindo classification 2 or higher were all with postoperative infection in the obesity group (3/145, 2.1％), and was significantly more common in the obesity group (3/27, 11.1％) than in the non-obesity group (p=0.01). Perioperative infection strategy is recommended for obese patients. Robot-assisted surgery for obese patients with a BMI of 30 or greater is probably a valuable procedure that can be performed as safely as in non-obese patients.