ASSESSMENT OF THE CONDITION OF PATIENTS WITH MORBID OBESITY DURING ROBOT-ASSISTED HYSTERECTOMY
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Abstract
Objective – to study the features of surgical treatment and reduce the incidence of complications in patients with morbid obesity with benign and malignant diseases of the internal genital organs using a robotic system.
Materials and methods. This single-center, comparative, non-randomized, prospective study included patients who underwent laparoscopic and robotic-assisted hysterectomy between 2015 and 2025. Patients were divided into groups based on the chosen approach. Group I (robot-assisted) included 60 patients, and Group II (laparoscopic) included 30 patients.
Results. The average duration of robotic-assisted hysterectomy was 99.1 minutes, while laparoscopic hysterectomy took an average of 90.4 minutes. Postoperative pain intensity assessment revealed no statistically significant differences between the groups. Postoperatively, cortisol levels returned to reference values in Group I, while they remained elevated in Group II. Two hours after surgery, TSH levels stabilized, approaching preoperative values; however, in Group II, the median TSH concentration remained higher (by 1.12 IU/L). The difference in median prolactin concentrations in the intra- and postoperative periods was statistically significant (782.2 mIU/L in Group I and 515.7 mIU/L in Group II, p < 0.05). Comparison of perioperative data on the neuropeptide substance P revealed a statistically significant difference in median concentrations in the intra- and postoperative periods – 6.033 ng/ml and 2.854 ng/ml, respectively.
Conclusions. Morbid obesity determines characteristic patterns of surgical stress markers during hysterectomy. The use of robotic-assisted surgery not only improves the quality of medical care during the procedure but also contributes to a more favorable surgical outcome. Postoperative care for these patients is also more favorable, primarily due to a reduced risk of decompensation of somatic diseases and severe pain.
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