{"paper_id":"2b0df9ce-6d01-49e1-8b8a-14fde98d818e","body_text":"Copyright© 2025 The Author. Published by Galenos Publishing House on behalf of European Society for Gynaecological Endoscopy. \nThis is an open-access article under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) License.\nFacts Views Vis Obgyn \nVIDEO COMMENTARY\nCorresponding Author: Benedetta Alberghetti, MD, Ovarian Cancer Center, Candiolo Cancer Institute, FPO-IRCCS, Torino, \nItaly \nE-mail: benedetta.alberghetti@ircc.it ORCID ID: orcid.org/0009-0002-6940-7522\nReceived: 31.01.2025 Accepted: 27.10.2025 Epub: 08.12.2025 \nCite this article as: Alberghetti B, Casetta E, Biscione A, Capomacchia FM, Hughes JM, Ponzone R, et al. Da Vinci Single Port \nin a obese woman affected by endometrial cancer. Facts Views Vis Obgyn. [Epub Ahead of Print].  \nABSTRACT\nBackground: Minimally invasive surgery in obese patients is advantageous in terms of postoperative recovery and \nestimated blood loss. In literature several retrospective studies comparing robot-assisted and laparoscopic surgery are \npresent, while a randomised case-control study will better define the advantages prospectively.\nObjectives: Here we present the video of the surgical radical management for endometrial cancer in an obese woman \nusing the Da Vinci Single-Port (SP) robotic platform.\nParticipant: A 66-year-old woman with a body mass index (BMI) of 44 kg/m² and hypertension, diagnosed with grade 1 \nendometrioid endometrial cancer.\nIntervention: The patient underwent a SP Robotic assisted radical class A hysterectomy (as per the Querleu-Morrow \nclassification), bilateral salpingo-oophorectomy and sentinel lymph-node biopsy. A 2.7 cm umbilical incision was \nperformed, and the single port robotic trocar was easily positioned. A uterine manipulator was not employed; traction \nwas achieved using vaginal valves. Due to her constitution, a pneumoperitoneum with an intra-abdominal pressure \ngreater than 8 mmHg and a Trendelenburg inclination greater than 19° could not be achieved.\nResults: Docking time was 8 minutes, the console time was 84 minutes, and the total operation time was 128 minutes. \nThe estimated blood loss was 200 mL. The pain scores were irrelevant. The duration of hospitalisation was 2 days. No \nperioperative early complications were recorded. The aesthetic result was good.\nConclusions: To our knowledge, this is the first Da Vinci SP endometrial cancer treatment in an obese woman presented \nin a step-by-step video. Robotic surgeries were successfully performed, the triangulation of the instrument allowed for \ncomfortable surgery. Therefore, this surgical system may also be applicable to patients with a high BMI; however, further \nstudies are required to confirm these preliminary findings.\nWhat is New? Minimally invasive surgery offers important benefits in terms of recovery, pain control, and reduced \nblood loss; however, its application in obese patients often remains challenging. The technical limitations imposed by \nbody habitus—restricted working space, limited Trendelenburg positioning, and difficulties in trocar placement—can \ncompromise both surgical exposure and oncologic radicality. In this context, the introduction of the Da Vinci SP robotic \nplatform may represent a meaningful evolution in the management of this increasingly common patient population. \nThe flexibility of the multi-jointed SP instruments and the ergonomic advantages of robotic control allow surgeons to \novercome the typical restrictions encountered in this population.\n1Ovarian Cancer Center, Candiolo Cancer Institute, FPO-IRCCS, Torino, Italy \n2Candiolo Cancer Institute, FPO-IRCCS, Torino, Italy \n3 Department of Gynecology Oncology, Candiolo Cancer Institute, FPO-IRCCS, Torino, Italy\n4Università Cattolica del Sacro Cuore, Institute of Obstetrics and Gynecology, Rome, Italy\n5Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy\n6Università Cattolica del Sacro Cuore, Institute of Obstetrics and Gynecology, Rome, Italy \n Benedetta Alberghetti1,  Elena Casetta 1,  Antonell Biscione1,  Filippo M. Capomacchia1, \n James M. Hughes2,  Riccardo Ponzone3,  Riccardo Oliva4,  Francesco Fanfani5,6,  Giovanni Scambia5,6, \n Luigi C. Turco1\nDa Vinci Single-Port surgery in an obese woman affected \nby endometrial cancer \nDOI: 10.52054/FVVO.2025.23\n\n\nAlberghetti et al. Da Vinci Single Port in obese woman with endometrial cancer \nVideo 1. Da Vinci single-port surgery in an obese woman affected by endometrial cancer:  \nhttps://youtu.be/P3ZK26Lgs0k\nVideo 1. Minimally invasive surgery is currently the \ngold standard in the treatment of most gynaecological \npathologies,1,2  both benign and oncological. In particular, \nrobotic surgery offers us greater surgical precision and \nallows us to treat patients with high body mass indexes \n(BMIs) that would be more complex with laparotomic or \nlaparoscopic approach.3,4,5 In this article we report step \nby step the surgical treatment using Da Vinci Single Port \nplatform for endometrial carcinoma in a patient with \nsevere obesity for which there were important limitations \nin terms of the need for Trendelemburg reduction and the \nuse of low pneumoperitoneum pressure. We report the \ntiming of each surgical step and the clinical outcomes of \nthis case. It’s conceivable this new surgical system could \nbe applied also in patients with high BMI.\nAcknowledgments: Not necessary.\nContributors: Surgical and Medical Practices: E.C., A.B., \nJ.M.H., B.A., L.C.T., Concept: E.C., A.B., B.A., L.C.T., \nDesign: E.C., R.P ., R.O., B.A., L.C.T., Data Collection or \nProcessing: E.C., A.B., F .M.C., L.C.T., A.B., Analysis or \nInterpretation: E.C., R.O., F .F ., G.S., L.C.T., A.B., Literature \nSearch: E.C., L.C.T., A.B., Writing: E.C., L.C.T., A.B.\nFunding: Not applicable.\nCompeting interests: Not applicable.\nEthical approval: Not applicable. \nInformed consent: Written informed consent was \nobtained from the study participant.\nData sharing: Data is available on request from the \nauthors.\nTransparency: Authors affirms that the manuscript is an \nhonest, accurate, and transparent account of the study \nbeing reported; that no important aspects of the study \nhave been omitted; and that any discrepancies from the \nstudy as planned (and, if relevant, registered) have been \nexplained.\nABSTRACT\nWe believe that this report highlights an important step toward expanding the accessibility of minimally invasive radical surgery \nto all patients, regardless of BMI. The SP robotic approach combines surgical radicality, patient safety, and reduced invasiveness, \nsuggesting a new paradigm for treating endometrial cancer in obese women.\nKeywords: Endometrial cancer, hysterectomy, laparoscopic surgery, pain, robotic-assisted, robotic surgery","source_license":"CC0","license_restricted":false}