229 Robotic Cholecystectomy: Utility in Morbidly Obese Patients

Abstract Aim Minimal data suggest the superiority of robotic cholecystectomy (RC) for outcomes, however robotic surgery may benefit specific patient cohorts, such as the morbidly obese (BMI 40 m/kg2). We present outcomes in RC from a single institution with a significant proportion of patients with class III & IV obesity. Method A retrospective analysis of RCs performed over 30 months was conducted, assessing cases for indicative pathology, complications, length of stay, BMI and comorbidity. Comparison was made between patients with BMI <40 m/kg2 and BMI >40 m/kg2. Results 120 elective RCs were performed for either gallstone disease (95%) or gallbladder polyps (5%) (DaVinci Xi platform). BMI data was available for 102 of the patients and demonstrated a skew toward overweight and obese patients (16% normal, 23% overweight, 19% class I obese, 14% class II obese, 24% class III obese and 4% class IV obese). No conversion to open was required, but 4 cases with BMI <40 m/kg2 required subtotal cholecystectomy. The complication rates were low and comparable: 4% in the BMI <40 m/kg2 group, versus 3.57% in the BMI >40 m/kg2 group. Overnight admission was required in 25.7% of the BMI <40 m/kg2 group, versus 39.3% in the BMI >40 m/kg2 group. However, the reasons for increased length of stay for the morbidly obese cohort did not relate to surgical complication or patient comorbidity. Conclusions RC may provide a low-risk approach for morbidly obese patients who often present as surgically or anaesthetically challenging.