Obesity and robotic surgery: Associated ventilator indices and perioperative pulmonary complications.

Abstract

5596 Background: Robotic surgery has been shown to be feasible in obese patients. However, there remains concern about the safety of robotic surgery in obese women who need gynecologic surgery, as the positioning required for pelvic surgery can exacerbate obesity-related changes in respiratory physiology. Our objective was to evaluate success and complication rates in obese women undergoing robotic gynecologic surgery and to assess variables that may be associated with complications. Methods: A retrospective chart review was performed on 1,035 obese patients who underwent robotic gynecologic surgery at two academic institutions between 2006 and 2012. Primary outcome was pulmonary complications. Secondary outcome was all-cause complications. Univariate logistic regression analysis was used to determine associations between patient baseline variables (age, BMI), operative variables (case length, trendelenburg time), ventilator parameters (tidal volume, peak inspiratory pressure) and complications (pulmonary, cardiac, other). Results: 146 patients (14%) had any complication. Only 33 patients (3%) had a pulmonary complication. Mean BMI was 39. Only increasing age was associated with a higher rate of pulmonary complications (p=0.03). None of the other patient variables including BMI, operative variables, or ventilator parameters were associated with pulmonary complications. Both age and longer case time were associated with a higher rate of all-cause complications (p<0.0005 and p=0.0028 respectively). Conclusions: The vast majority of obese patients can successfully tolerate robotic gynecologic surgery, and have overall low complications rates and even lower rates of pulmonary complications. Obesity was not predictive of robotic surgery tolerance or complications and can be safely undertaken in obese and even morbidly obese patients without significant complications.