Single-Site Versus Multiport Robotic Hysterectomy in Obese Patients With Endometrial Cancer : a Multicentre Retrospective Evaluation of Surgical and Oncological Outcomes

Introduction: The aim of this study is to compare robotic single-site hysterectomy (RSSH) and robotic multiport hysterectomy (RMPH) for EC in obese patients in term of surgical outcomes.Material and methods: This study compares RSSH with RMPH in obese patients with EC and FIGO stage I or II. According to their Body Mass Index (BMI), patients were divided in 3 groups: from 30 to 34.9 kg/m2 (group A), from 35 to 39.9 kg/m2 (group B) and 40 kg/m2 or higher (group C). Results: We included 225 patients: 76 in the RSSH group divided, respectively, in 53, 18 and 5 in the A, B and C groups; 149 in the RMPH group divided, respectively, in 76, 37 and 36 in the A, B and C groups. When the A classes in the two groups were compared, the median Operative Time (OT) and Blood Loss (EBL) were lower in the RSSH group (respectively p=0.02 and p<0.0001). Furthermore, the median EBL increased when the BMI increased in the RSSH group (p=0.01). As regards the conversion rate, it increased when the BMI increased in the RSSH group (p<0.0001). Lastly, the median hospital stay was higher in the RMPH group when the A classes were compared (p=0.002).Conclusion: The advantages of RSSH in terms of reduced invasiveness, post-operative pain and hospital stay, which have been demonstrated in non-obese patients, remain true only in the first BMI class. When the BMI increased all these advantages are lost, especially in extremely obese patients (>40 kg/m2).