A case of robot-assisted hysterectomy followed by left adnexectomy for atypical endometrial hyperplasia and left ovarian teratoma in a severely obese Japanese woman

Robot-assisted hysterectomy for early endometrial cancer and benign gynecologic diseases has been covered by the public health insurance system in Japan since April 2018, and the number of cases has steadily increased. However, few reports exist of robot-assisted hysterectomy in severely obese Japanese women [body mass index (BMI) >50]. Herein, we report a case of robot-assisted hysterectomy followed by left adnexectomy for atypical endometrial hyperplasia and left ovarian teratoma in a Japanese woman with a BMI of 50.8. A 43-year-old nulliparous woman with a height of 161.2 cm and body weight of 132 kg was referred to our facility for the treatment of abnormal uterine bleeding. Endometrial biopsy revealed atypical endometrial hyperplasia, and magnetic resonance imaging revealed endometrial thickness of 23 mm and a left ovarian teratoma of 7 cm. Since the patient was unlikely to undergo a successful future pregnancy, we performed a robot-assisted hysterectomy, left adnexectomy, and right salpingectomy using the da Vinci Xi surgical system. We set four ports at the height of the umbilics, all of which were made along skin striae, and added an assistant port at a point 8 cm above and 8 cm lateral to the umbilics. The excised uterus and left ovary were vaginally removed without morcellation. No complications have occurred, and the four wounds were hidden by abdominal fat; therefore, the patient was satisfied with the surgical outcome. In conclusion, robot-assisted hysterectomy is well tolerated in severely obese Japanese women, and the inconspicuous wounds are cosmetically acceptable.