Research on the spectrum of complications in robotic surgery for obese urologic patients: a 6-year retrospective study

The prevalence of obesity has reached epidemic proportions globally, with obese patients facing significantly higher perioperative risks due to anatomical and physiological challenges. While robot-assisted surgery (RAS) offers potential advantages through 3D high-definition imaging and tremor filtering capabilities, comprehensive safety data for obese patients remains limited. This study aimed to evaluate the safety profile and complication spectrum of robotic surgery in obese patients. A retrospective observational study was conducted at the First Affiliated Hospital of Anhui Medical University from January 2019 to March 2025. Inclusion criteria were age ≥ 18 years, BMI ≥ 28 kg/m², and da Vinci robotic system-assisted surgery. Clinical data including patient characteristics, surgical outcomes, and complications were analyzed. Patients were stratified by obesity severity: mild (28 ≤ BMI < 32.5 kg/m²), moderate (32.5 ≤ BMI < 37.5 kg/m²), and severe (37.5 ≤ BMI < 50 kg/m²). A total of 299 obese patients were included: 109 underwent radical prostatectomy, 150 partial nephrectomy, and 40 ureteral reconstruction. No robotic malfunctions or conversions to open surgery occurred. Overall complication rates were low, with incisional pain (5.7%) and fever (2.3%) being most common. Complications were predominantly Clavien-Dindo grades I and II. Serious complications including pulmonary embolism (0.3%), delayed bleeding (0.3%), and critical myoglobin value (0.3%) occurred rarely. BMI subgroup analysis revealed complication rates of 11.3% in mild obesity, 5.3% in moderate obesity, and 0% in severe obesity, suggesting higher BMI did not increase complication rates. Robot-assisted surgery demonstrates a high safety profile in obese patients with low overall complication rates. While most complications were minor and manageable, attention should be paid to postoperative pain management, infection prevention, and thromboembolic risk assessment. These findings support the safety and feasibility of robotic surgery in the obese population.