子宫内膜癌（EC）是发达国家最常见的妇科恶性肿瘤，子宫内膜上皮内瘤变（EIN）是明确的癌前病变。肥胖被认为是 EC 和 EIN 的危险因素。另一方面，早期 EC 患者的死亡率通常归因于肥胖相关疾病。减肥手术已被证明可以改善 EC 患者的肿瘤结果以及肥胖相关的发病率和死亡率。因此，针对子宫疾病和肥胖症的联合手术是最近的关注点。在这里，我们发布了一篇视频文章，展示了对超级肥胖和 EIN 患者进行同步机器人辅助全腹腔镜子宫切除术和袖状胃切除术的关键手术步骤。一名 40 多岁的患者，体重指数为 62.4 kg/m²，诊断为 EIN，计划接受联合手术。手术从反特伦德伦伯卧位的袖状胃切除术开始。手术使用带有左侧对接的达芬奇 Xi 手术系统™（Intuitive Surgical Inc.，桑尼维尔，加利福尼亚州，美国）。胃动员后，使用吻合器进行胃切除术。袖状胃切除术后，患者处于特伦德伦伯卧位，机器人系统被定位以进行子宫切除术。进行了子宫切除术和输卵管切除术。通过阴道取出切除的胃和子宫切除材料。冰冻检查发现EC低于2厘米，有浅表浸润，并进行了双侧卵巢切除术。整个手术大约持续了4个小时。术后未出现并发症，患者于第3天出院。© 2025。亚洲妇科肿瘤学会、韩国妇科肿瘤学会、日本妇科肿瘤学会。

Endometrial cancer (EC) is the most common gynecological malignancy in developed countries, and endometrial intraepithelial neoplasia (EIN) is the defined precancerous lesion. Obesity is considered a risk factor for both EC and EIN. On the other hand, mortality is often attributed to obesity-related conditions in patients with early-stage EC. Bariatric surgery has been shown to improve oncological outcomes and obesity-related morbidity and mortality in patients with EC. Therefore, combination surgery addressing both uterine disease and obesity is a very recent point of interest. Here, we present a video article to demonstrate the crucial surgical steps for a simultaneous robotic-assisted total laparoscopic hysterectomy and sleeve gastrectomy in a patient with super obesity and EIN. A patient in her 40s with a body mass index of 62.4 kg/m² and a diagnosis of EIN was scheduled for combo surgery. The operation started with sleeve gastrectomy in the reverse Trendelenburg position. The da Vinci Xi Surgical System™ (Intuitive Surgical Inc., Sunnyvale, CA, USA) with left-side docking was used for surgery. After the mobilization of the stomach, gastric resection was performed using a stapler. Following sleeve gastrectomy, the patient was positioned in the Trendelenburg position, and the robotic system was positioned for hysterectomy. Hysterectomy and salpingectomy were performed. The excised stomach and hysterectomy material were removed through the vagina. A frozen examination revealed EC below 2 cm with superficial invasion, and bilateral oophorectomy was performed. The whole surgery took approximately 4 hours. No postoperative complications occurred, and the patient was discharged on the 3rd day.© 2025. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology.