Panniculectomy in gynecologic cancer surgical procedures by using a harmonic scalpel

Objective. To demonstrate that panniculectomy in obese gynecologic oncology patients undergoing surgical gynecologic procedures reduces operative time, gives better surgical exposure and does not increase the number of operative complications. Methods. A retrospective review of 90 patients who had panniculectomy at the time of gynecologic surgery between 1992 and June 2003. Analyzed data included indication for surgery, patient's weight, operative times, blood loss and complications. Results. Panniculectomy was performed in 20 patients operated because of uterine cervix cancer and 70 because of uterine body cancer. The mean age was 57.3 years, weight 126.7 kg and body mass index (BMI) 47 kg/m(2). The following procedures were performed: radical hysterectomy by the Wertheim-Meigs method (22 cases), total hysterectomy (68 cases) with bilateral salpingoophorectomy, pelvic lymphadenectomy and also periaortal lymphadenectomy (four cases). The mean operative time was 169 min, including from 20 to 25 min opening and closing time, and blood transfusion was undertaken in 15.6% of patients. The average weight of removed panniculus was 4900 g. In 82.2% of patients there were no wound complications, in 17.8% the healing was delayed. Daily drains secretion was 65.3 mL (range 0-300 mL). One patient died because of pulmonary embolism, and another because of myocardial infarction. There were no cases of damage to the urinary tract, intestines or large vessels. During the histopathological examination metastatic carcinoma in lymph nodes was found in 29.3% of the cases. Conclusions. Massively obese women can safely undergo gynecologic oncological surgery with simultaneous panniculectomy. Panniculectomy improves surgical access and facilitates radical surgery.