NEWS World's First Successful Single-Port Robotic Hysterectomy in a Woman with BMI 52... Record-breaking Obesity Case 2024.05.29

UAE Woman with Severe Pelvic Pain After Childbirth and Multiple Surgeries… Faces Hysterectomy Challenge Due to Morbid Obesity

AMC team led by Professor Sa Ra Lee Safely Performs Robotic Hysterectomy Despite High-Risk Surgical Conditions


▲ Professor Sa Ra Lee (left) of the Department of Obstetrics and Gynecology at Asan Medical Center is performing a robotic surgery


After suffering from severe pelvic pain following childbirth and multiple surgeries, an Emirati woman, weighing 124 kilograms at a height of 154 cm, was unable to undergo further surgeries due to extreme morbid obesity. However, she found relief from her pain through robotic hysterectomy in a distant land, South Korea.


For the first time worldwide, a high-risk patient with a Body Mass Index (BMI) of 52 and numerous surgical adhesions underwent a hysterectomy using a single-port (SP) robotic system. Previously, the most obese patient recorded for a robotic hysterectomy had a BMI of 41.5.


The team led by Professor Sa Ra Lee from the Department of Obstetrics and Gynecology at Asan Medical Center recently announced their success in safely performing a hysterectomy for Jamila (pseudonym, 38 years old), a severely morbidly obese patient from the UAE suffering from severe adhesions, endometriosis, and pelvic pain caused by previous cesarean sections and ovarian surgeries. They utilized the Da Vinci SP system, making only a single incision inside the navel, to successfully remove the uterus.


In 2022, Jamila gave birth to twins, her third and fourth children, in her home country, the UAE. However, in June of that year, an ultrasound examination revealed small uterine fibroids, along with severe pelvic adhesions and a hydrosalpinx (a condition where the fallopian tube fills with fluid due to damage or infection).


Two months later, in August, she underwent laparoscopic adhesion removal and salpingectomy, yet even after four months, the pelvic pain persisted. Consequently, in December, she underwent additional treatment with a Mirena device to address pelvic pain and excessive menstrual bleeding. As 2023 approached, she continued attending pain clinics in an effort to alleviate her symptoms, but there was no sign of improvement.


As a mother who had to care for her four children, Jamila had no choice but to turn her attention to overseas hospitals that could alleviate her pain as quickly as possible. The Department of Health-Abu Dhabi searched for hospitals abroad where Jamila could undergo surgery, and the International Health Center at Asan Medical Center assessed Jamila's suitability for surgery through remote consultation.


Due to severe adhesions from previous surgeries and her morbid obese condition, there were significant concerns that the incision site from open surgery would not heal well, posing a high risk of wound complications.


Professor Sa Ra Lee determined that minimizing the incision site would benefit the patient's post-operative recovery. Despite the high level of difficulty, she decided to proceed with robot-assisted surgery instead of open surgery.


Professor Sa Ra Lee had previously pioneered the use of single-port robotic surgery for pelvic organ prolapse, being the first in the world to perform such procedures and subsequently presenting related research papers and surgical videos at the American Association of Gynecologic Laparoscopists (AAGL). Additionally, she had extensive experience in robotic surgeries for gynecological conditions, including achieving a milestone of 400 cases of robot-assisted sacrocolpopexy, a treatment for pelvic organ prolapse, making her the first in Asia to do so.


In January 2024, Jamila arrived at Asan Medical Center after a flight of over 10 hours, holding onto the hope of a successful surgery. On February 13, Professor Sa Ra Lee successfully performed the robotic hysterectomy through a single incision inside the navel.


Following a smooth recovery over the next month, Jamila returned to the UAE on March 11, with minimal scarring from the small incision, to reunite with her four children.


Professor Sa Ra Lee commented, "This surgery represented the highest BMI among cases of single-port robotic hysterectomy performed on morbidly obese patients. Although it was a challenging decision, we prioritized the patient's safety and conducted numerous simulations to ensure a successful outcome. Fortunately, the surgery went well, and the patient can now live a pain-free life."


In a recent thank-you letter to Professor Sa Ra Lee, Jamila wrote, "The surgery went smoothly, and I experienced minimal pain. The surgical scar is very small and hidden inside my navel. I am deeply grateful to the medical staff and the International Health Center for their meticulous care throughout the treatment process."


Meanwhile, Asan Medical Center continues to lead in training international medical professionals under a contract with the Saudi Arabian government. In early May, the Saudi Arabian Minister of Education visited the center, observing a Da Vinci SP surgery for pelvic organ prolapse performed by Professor Sa Ra Lee and attended by Saudi trainees.