Impact of obesity on perioperative outcomes in robot-assisted surgery for endometrial cancer: A single-center study of 119 cases

Introduction: Whether obesity (body mass index [BMI] ≥30 kg/m²) independently affects perioperative outcomes in robot-assisted surgery for endometrial cancer remains uncertain. Materials and methods: We conducted a retrospective single-center cohort including 119 consecutive patients who underwent a uniform robotic procedure-total hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy using the da Vinci Xi system-between November 2018 and June 2025. Patients were grouped by BMI ≥ 30 (n = 32) versus < 30 (n = 87). Outcomes were estimated blood loss (EBL), operative time, lymph-node yield, and length of stay (LOS). Multivariable linear regression adjusted for age, prior abdominal/pelvic surgery, comorbidity history (diabetes, hypertension, dyslipidemia), operating surgeon, and surgical year (2018-2020 vs 2021-2025). Results: BMI ≥ 30 was independently associated with higher EBL and longer operative time, and prior surgery also prolonged operative time. Surgeon effects were pronounced for efficiency and nodal retrieval; BMI was not associated with lymph-node yield. LOS was not associated with BMI; however, LOS was higher in later surgical years and varied by surgeon. Conclusion: In standardized robot-assisted endometrial cancer surgery, obesity increased intraoperative workload (blood loss and operative time) without reducing lymph-node yield. LOS reflected surgeon- and time-related factors rather than BMI. These findings support the feasibility of robotic surgery in patients with obesity and underscore the importance of surgeon experience, pathway fidelity, and ongoing quality improvement.