Total laparoscopic hysterectomy in morbidly obese women with endometrial cancer anaesthetic and surgical complications

Objective: To assess the feasibility, associated anaesthetic and surgical morbidity in all morbidly obese women with endometrial cancer treated with total laparoscopic hysterectomy bilateral salpingo-oophorectomy (TLHBSO). Study design: Data was collected prospectively and analysed retrospectively on all morbidly obese women who had TLHBSO between February 2003 and January 2007. Results: One case was converted to laparotomy. The mean postoperative stay was 4.04 (3-7) days. The only postoperative surgical complication was an incisional port site hernia. Comorbidities were present in 76% (26/34) of women, 29% (10/34) had a single comorbid condition, and 26% (9/34) had two. A further 21% (7/34) had more than two. There were no major anaesthetic complications. Patients with a BMI > 50 required ventilation with high airway pressure despite using ventilatory strategies to keep them to a minimum. Conclusion: TLHBSO in the obese population is safe in the hands of experienced surgeons and anaesthetists. The safety of a total laparoscopic approach in the surgical management of uterine cancer remains to be demonstrated ill prospective randomised trials.