Minimially invasive surgery in high BMI patients
The prevalence of obesity is rising worldwide, especially in western societies. Health problems in obese and increased BMI patients that require surgical treatment increases as well. However, as we aim towards personalized treatment, we have to be aware that this particular patient category poses specific challenges as far as surgical complexity and surgery-related risks are concerned.
In the United States, the prevalence of obesity is roughly 35% in adults. In pelvic surgeries, numerous international scientific communities acknowledge the benefits and advantages of robotic surgeries. (i.e., urologic, gynecologic, distal colorectal surgery), robotic assistance conveys certain advantages.
According to Anesthesia Patient Safety Foundation: “for patients with increased subcutaneous tissue, robotic surgery can decrease the physical demand and strain on the surgeon while increasing precision and mobility with the use of wristed surgical instruments.”
Studies suggest that compared to conventional laparoscopy, robotic surgery has statistically significantly less chance to convert to open surgery during the procedure. At the same time, it is safe, and even in cancer cases, oncological outcome benefits from robotic surgery. // Corrado G, Vizza E, Cela V (2018) Laparoscopic versus robotic hysterectomy in obese and extremely obese patients with endometrial cancer: A multi-institutional analysis. Eur J Surg Oncol.Dec;44(12):1935-194
Davenport, W. B., M. P. Lowe, D. H. Chamberlin (2012). “Outcomes of obese versus non-obese subjects undergoing robotic-assisted hysterectomy: a multi-institutional study.” Journal of Robotic Surgery: 1-6.
How robotic surgery benefits these patients?
Individual technical specifications provided by robotic systems allow as modifying our surgical approach and relieving obese patients from additional surgical stress.
Robot-assisted surgery advantages:
Lower intra-abdominal pressures,
The flexibility of instruments that can access all parts of the female pelvis,
Offers relaxed surgeon’s body posture that reduces surgical fatigue of doctors
Increased dexterity irrespective of adipose fat
These factors add to cardiovascular and respiratory changes that occur during surgery as well as postoperatively. Obese patients experience difficulties with deep breathing and early mobilization after surgeries. By including obese patients in the number of minimally invasive surgical candidates, allows us to offer them the advantages mentioned above.