A Successful Ventilatory Approach in a Severe Class 3 Obesity Patient Undergoing Robotic Gynecological Surgery

Background: Robotic gynecologic surgery offers enhanced precision but requires Trendelenburg position and pneumoperitoneum, which can affect respiratory function, especially in patients suffering from obesity. Currently, there is limited evidence to establish the optimal ventilation strategy for severe Class 3 obesity patients undergoing robotic gynecologic surgery. Case Presentation: A 47-year-old woman with a body mass index of 60 kg/m2 underwent a robotic-assisted hysterectomy and bilateral ovariectomy for endometrial cancer. Volume-controlled inverse ratio lung-protective mechanical ventilation with individualized positive end-expiratory pressure guided by driving pressure and mechanical power was used to manage the patient’s ventilation. Her oxygenation remained stable throughout the surgery, and there was no evidence of postoperative pulmonary complications. Conclusion: Individualized positive end-expiratory pressure within the framework of volume-controlled inverse ratio lungprotective mechanical ventilation guided by driving pressure and mechanical power should be considered in severe Class 3 obesity patients undergoing robotic gynecologic surgery.