Endometrial cancer is becoming more common over the world, largely because more people are becoming obese. It is the most common type of gynecological cancer in industrialized countries. Obesity is known to raise the risk of endometrial cancer because it makes the body resistant to insulin, changes the way it metabolizes food, and exposes the body to estrogen for a long time. Obesity is linked to a higher risk of endometrial cancer and makes surgery harder in many ways, such as by causing more issues during and after surgery, longer operating times, and longer hospital stays [1-3]. A complete hysterectomy and bilateral salpingo-oophorectomy are the principal treatments for early-stage endometrial cancer. Obese patients receiving laparotomy had an elevated risk of wound infection, dehiscence, thromboembolic events, and pulmonary complications in comparison to those undergoing the procedure by the conventional open abdomen technique. Because of these risks, oncologists are turning toward surgical procedures that are less invasive yet still lower the risk of complications after surgery [4-6]. There is a lot of evidence that laparoscopic hysterectomy is better than open surgery. It causes less blood loss, a shorter hospital stay, and a faster recovery. But standard laparoscopy in obese women might be challenging to do because the instruments can't move around easily, the surgeon can't see well, and the physician is tired. Robotic-assisted surgery is superior to traditional laparoscopy because it offers three-dimensional imaging, better ergonomics, tremor filtering, and more dexterity. These qualities may be especially helpful when operating on overweight patients [7, 8]. According to several research, robotic hysterectomy has demonstrated good results in endometrial cancer patients before and after surgery. These results include lower conversion rates and complication profiles that are easy to handle, especially in women with a high body mass index. But there isn't much information about overweight women in general or in places with minimal resources. To assess the efficacy, safety, and feasibility of robotic surgery in this high-risk cohort, it is essential to analyse institutional outcomes [9, 10]. The current study aimed to evaluate the perioperative outcomes, complication rates, and short-term surgical results of robotic hysterectomy, contributing to the increasing evidence that it is a minimally invasive surgical option for obese women with endometrial cancer.

This was a prospective observational study carried out in the Department of Gynecologic Oncology at a tertiary care teaching hospital over an 18-month duration. This study was conducted at the Department of Surgery, Surabhi Institute of Medical Sciences, Siddipet, Telangana, India, between August 2022 to September 2023. The Institutional Ethics Committee approved the trial, and all subjects signed a written consent form before the procedure. The study comprised 40 obese women diagnosed with endometrial cancer who had robotic-assisted hysterectomy. A body mass index (BMI) of 30 kg/m² or higher was used to classify obesity. All patients were assessed preoperatively and treated in accordance with established oncological guidelines. Surgical Procedure: A standardized robotic-assisted complete hysterectomy procedure was performed on all patients, including bilateral salpingo-oophorectomy. Based on preoperative risk classification and intraoperative observations, pelvic lymphadenectomy was done selectively. All patients received standard perioperative treatment, which includes antibiotic and thromboprophylaxis prophylaxis. Data Collection: Details such as patient age, gender, height, weight, medical history, tumor type, estimated blood loss, time spent in the operating room, requirement for laparotomy conversion, complications during and after the procedure, and length of hospital stay were documented. For the first 30 days after surgery, patients were monitored to see how the procedure went and whether any problems arose. Inclusion Criteria: • Women aged ≥18 years • Body mass index (BMI) ≥30 kg/m² • Histologically confirmed endometrial carcinoma • Patients with early-stage disease (FIGO stage I–II) • Patients undergoing planned robotic-assisted hysterectomy • Willingness to provide informed consent Exclusion Criteria: • BMI <30 kg/m² • Advanced endometrial cancer (FIGO stage III–IV) • Patients requiring primary laparotomy • History of previous pelvic radiotherapy • Severe cardiopulmonary illness contraindicating robotic surgery • Patients unwilling or unable to complete postoperative follow-up Statistical Analysis: Microsoft Excel was used for data entry, and SPSS, or the Statistical Package for the Social Sciences, was used for analysis. Mean ± standard deviation was used to represent continuous variables, whilst frequencies and percentages were used to portray categorical variables. When appropriate, we used the independent t-test for continuous variables and the Chi-square test or Fisher's exact test for categorical data to evaluate associations between clinical factors and postoperative outcomes. Statistical significance was determined by a p-value less than 0.05.

The final study comprised 40 obese women who had robotic-assisted hysterectomy for endometrial cancer that had been proven histologically. For the purpose of evaluating perioperative outcomes and complications, all patients were monitored for 30 days after surgery. Table 1. Baseline Demographic and Clinical Characteristics of the Study Population Variable Category Number (%) Age (years) ≤50 10 (25.0) 51–60 16 (40.0) >60 14 (35.0) Mean age (years) — 56.4 ± 7.8 BMI (kg/m²) 30–34.9 22 (55.0) 35–39.9 13 (32.5) ≥40 5 (12.5) Mean BMI (kg/m²) — 34.6 ± 3.9 Diabetes mellitus Present 18 (45.0) Hypertension Present 21 (52.5) Most of the patients (75%) were over the age of 50, and their average age was 56.4 ± 7.8 years. The percentage of patients with class I obesity was over 50%, and 12.5% were considered very obese (BMI ≥40 kg/m²). Comorbidities such as diabetes mellitus (45%) and hypertension (52.5%) were prevalent in the patient population. Table 2. Tumor Characteristics and Surgical Details Variable Category Number (%) FIGO stage IA 28 (70.0) IB 12 (30.0) Histological type Endometrioid adenocarcinoma 34 (85.0) Non-endometrioid 6 (15.0) Pelvic lymphadenectomy Performed 16 (40.0) Not performed 24 (60.0) Mean operative time (minutes) — 168.5 ± 28.4 The majority of patients were in the early stages of the disease; in fact, 70% of cases were at FIGO stage IA. The histological subtype most commonly found was endometrioid adenocarcinoma. Risk classification informed the decision to undertake pelvic lymphadenectomy in 40% of patients. This procedure took an average of 168.5 ± 28.4 minutes. Table 3. Intraoperative Outcomes Variable Finding Estimated blood loss (mL) 132.6 ± 54.3 Blood transfusion required 2 (5.0%) Conversion to laparotomy 1 (2.5%) Intraoperative complications 2 (5.0%) During a robotic hysterectomy, the average estimated blood loss was 132.6 ± 54.3 mL, which is considered modest intraoperative blood loss. Only five percent of patients needed a blood transfusion. One patient had to have a laparotomy because there were so many adhesions. Very few intraoperative problems occurred, and those that did were effectively handled. Table 4. Postoperative Complications (within 30 days) Complication Number (%) No complications 32 (80.0) Wound-related complications 3 (7.5) Postoperative ileus 2 (5.0) Urinary tract infection 1 (2.5) Overall postoperative complications 6 (15.0) The most prevalent postoperative consequence was related to wounds, which occurred in 15% of patients. The majority of the issues were small and were treated with caution. Perioperative mortality, pulmonary embolism, or deep vein thrombosis were not documented. Table 5. Postoperative Recovery and Short-term Outcomes Outcome Result Mean hospital stay (days) 3.4 ± 1.1 ICU admission required 2 (5.0%) Readmission within 30 days 1 (2.5%) Re-operation 0 Perioperative mortality 0 The short amount of time patients spent in the hospital after robotic surgery (3.4 ± 1.1 days) indicates that they recovered quickly. Two patients needed to be admitted to the intensive care unit for short-term monitoring. Obese women who had robotic hysterectomy had good short-term results, with no re-ops or perioperative deaths.

Endometrial cancer surgery is complicated when the patient is overweight, since traditional open surgical techniques might increase perioperative morbidity. Results showed that robotic-assisted hysterectomy is a safe and feasible minimally invasive technique with acceptable operative times, low blood loss, minimal conversion rates, and favorable short-term outcomes in obese women with endometrial cancer. The present prospective study evaluated the perioperative outcomes of this procedure [11-13]. As is common for endometrial cancer, the majority of patients in this study had early-stage disease; in fact, 70% of cases were classified as FIGO stage IA. Prior research on robotic hysterectomy in obese and severely obese individuals found that the average operating time was around 168 minutes, which is consistent with these findings. Robotic methods seem to alleviate the difficulties associated with technical complexity, which could cause surgical times in obese women to be longer, by providing improved visualization and tool dexterity [14-16]. The current study had a modest percentage of patients who needed blood transfusions and a low estimated blood loss. Obese patients, who are more likely to experience postoperative problems, can greatly benefit from minimally invasive surgery's well-documented advantage of reduced blood loss. The technical feasibility of robotic surgery in this patient population, despite the higher body mass and accompanying anatomical obstacles, is further demonstrated by the low conversion rate to laparotomy (2.5%) [17-19]. Overall, the rate of postoperative complications in this study was 15%, which is considered modest. Most side effects were mild and easily treated with conservative measures; the most common of them were problems with the wounds. Crucially, there were no reports of perioperative death, anastomotic leakage, or thromboembolic events. These results corroborate earlier research that found less wound problems and faster recovery times after robotic hysterectomy as compared to open surgery, especially for patients who are overweight [20-22]. The advantages of minimally invasive surgery in encouraging early mobilization and recovery are shown by the 3.4-day mean hospital stay observed in this study. Reduced healthcare expenditures and the likelihood of hospital-acquired problems are additional benefits of shorter hospital stays, in addition to increased patient satisfaction. Robotic hysterectomy appears to be safe for obese women with endometrial cancer, as there is little evidence of intensive care unit admission and readmission [23]. While these findings are promising, it is important to note that there are certain limitations. The findings may not be applicable to a broader population due to the study's small sample size and single-center design. In addition, the researchers did not look at cancer-related long-term outcomes like disease-free survival or overall survival. Validating these findings and directly comparing robotic hysterectomy to conventional laparoscopic and open surgical procedures in obese individuals would require further multicenter research with larger cohorts and extended follow-up [24, 25]. The study's findings contribute to the increasing amount of data that robotic-assisted hysterectomy is a safe and successful surgical alternative for obese women with endometrial cancer. It offers positive perioperative outcomes and maintains oncological adequacy [26].

Women who are overweight and have endometrial cancer have an option for a safe, practical, and effective surgical procedure: robotic-assisted hysterectomy. This technique was linked to acceptable operating times, low rates of mostly mild postoperative problems, limited conversion to laparotomy, and reduced intraoperative blood loss in the current investigation. Short hospital stays and low readmission rates after robotic surgery in this high-risk group show that patients recover quickly after the procedure. According to these results, robotic hysterectomy is able to maintain good perioperative outcomes despite numerous technical difficulties linked to obesity. The key to maximizing benefits is still careful patient selection, precise surgical technique, and the right perioperative optimization. Confirmation of these findings and evaluation of long-term oncological outcomes in obese women receiving robotic surgery for endometrial cancer require larger multicenter trials with longer follow-up. Funding None Conflict of Interest: None

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