Endometrial cancer represents the fourth cause of cancer in women in France, with over 8000 cases per year in 2018 [1,2]. Gold-standard surgery for most cases is total hysterectomy and bilateral adnexectomy with pelvic lymph node staging which is amenable to minimally invasive surgery [3]. Indeed, compared to open surgery, conventional and robotic assisted laparoscopy allow to have significantly more favorable perioperative outcomes (less bleeding, shorter hospital stays, use of less pain-relieving medication) without impacting oncological outcomes [[4], [5], [6]].

Obesity is a significant risk factor for endometrial cancer and approximately 60 % of patients with this disease have a Body Mass Index (BMI) > 30 kg/m [7,8]. In this specific population, several perioperative challenges, due to increasing BMI and comorbid condition, exist and can lead to important surgical morbidity [9]. Although minimally invasive approach has been shown to be the surgical technique of choice to reduce operative complications, conventional laparoscopy has limitations and notably in patients with very high BMI [10]. In those cases, robotic assisted laparoscopy may have more interest for the ergonomic impacts on the surgical team: articulated instruments, 3-D visualization, tremor reduction, shorter learning curve, and decreased pneumoperitoneum insufflation pressures [[11], [12], [13]]. Moreover, some studies demonstrated that robotic assisted laparoscopy has less blood loss and shorter hospital stays in very obese patients [12,14,15].

Morbid obesity can still impact perioperative outcomes even in robotic assisted laparoscopy. The aim of our retrospective study was to compare surgical and oncological outcomes between patients with BMI < 35 kg/m2 and patients with BMI ≥ 35 kg/m2 (morbid obesity) who underwent robotic assisted laparoscopic total hysterectomy with bilateral adnexectomy and pelvic lymph node staging.