With a great deal of interest we read the recent article in your journal entitled, “Obesity and perioperative pulmonary complications in robotic gynecologic surgery.” We agree with the authors of this fine paper that the vast majority of obese patients can successfully tolerate robotic procedures and the finding is very interesting that only 3% could have a pulmonary complication: eg, oxygen saturation (SpO2) <90%, delayed extubation or reintubation, pulmonary edema or pleural effusion, infection, inadequate tidal volume (TV), pulmonary embolus, and bronchospasm.

Obesity is strongly associated with the impairment of several components of the respiratory function. A recent metaanalysis showed that pulmonary morbidity is lower in laparoscopic (1.6%) compared to open (3.6%) procedures in obese patients. Meininger et al showed that in obese patients pneumoperitoneum transient decreased the impairment of arterial oxygenation and lead to decrease in alveolar-arterial difference in oxygen tension.

Some types of gynecological cancers such as endometrial cancer are obesity related. We would be interested to see a subanalysis of the patients’ data in gynecological oncology procedures such as robotic radical hysterectomy and robotic pelvic/paraaortic lymphadenectomy and the pulmonary complications of such a group of obese patients. Such types of operation need steeper Trendelenburg, and could last longer than procedures for benign conditions.

We would like once again to thank the authors for this very interesting retrospective study and we look forward to the outcomes of a possible subanalysis in the oncological obese patients’ group.