A prospective comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy in the extremely obese patient.
ABSTRACT To prospectively compare the outcomes of transperitoneal laparoscopic nephrectomy (TLN) and retroperitoneal LN (RLN) in extremely obese patients, as LN in such patients (body mass index, BMI >/= 40 kg/m(2)) is an accepted but technically challenging undertaking, and either approach to the kidney can be used.
Between July 1998 and August 2005, 51 consecutive patients with extreme obesity had 53 LNs at our institution (13 TLN and 40 RLN). Peri-operative data were collected prospectively in a database approved by the Institutional Review Board.
There were no statistically significant differences between the two approaches for several variables, including baseline BMI (44 vs 45; P = 0.23), muscle-splitting extraction incision length (7.0 vs 7.7 cm; P = 0.53), and intraoperative complications (none vs 5%; P = 0.99). RLN tended to cause less estimated blood loss (EBL, 150 vs 100 mL; P = 0.31), a shorter operation (190 vs 180 min; P = 0.11), larger specimen weight (682 vs 938 g; P = 0.078), lower intraoperative open conversion rate (15% vs 0%; P = 0.06), and a shorter hospital stay (53.6 vs 37.5 h; P = 0.33), although none of these variables was statistically significant at P < 0.05.
In the extremely obese patient, RLN tended to have advantages in EBL, operative duration, specimen weight, open conversion rate, and duration of hospital stay. RLN provides direct access to the renal hilum, and avoids the pannus and voluminous intra-abdominal fat encountered during TLN. These data and our experience support RLN as the technique of choice for LN in the extremely obese patient.
Article: Complications of laparoscopic surgery for renal masses: prevention, management, and comparison with the open experience.[show abstract] [hide abstract]
ABSTRACT: The initial excitement about the laparoscopic treatment of renal masses has been tempered by concerns related to increased operative time, technical complexity, and the suitability of laparoscopic approaches to oncologic surgery. To provide a comprehensive review of intraoperative and postoperative complications and their prevention and management during laparoscopic surgery of renal tumors. A literature review of the Medline and Google Scholar databases was performed, searching for renal cell carcinoma, renal mass, laparoscopy, laparoscopic radical nephrectomy, open radical nephrectomy, laparoscopic partial nephrectomy, open partial nephrectomy, laparoscopic cryoablation, laparoscopic radiofrequency ablation, complications, intra-operative, and post-operative. English-language articles published between 1990 and 2008 were reviewed. Laparoscopic radical nephrectomy (LRN), whether transperitoneal or retroperitoneal, can be performed safely. The overall complication rate is low and does not significantly differ from that of the open experience. Laparoscopic partial nephrectomy (LPN), in contrast, is a technically challenging procedure. Although the intermediate oncologic outcomes are comparable to those of the open experience, there are concerns related to warm ischemia time, and there is a risk of major complications such as urinary leakage and hemorrhage requiring transfusion. Laparoscopic-assisted ablative therapies (cryotherapy and radiofrequency) are being performed more commonly for the treatment of small exophytic renal lesions with a low complication rate and intermediate oncologic outcomes similar to LRN and LPN. Complications associated with the laparoscopic management of renal masses vary among the different procedures and with surgeon experience. The rate of complication appears to be similar to that of open surgery.European urology 02/2009; 55(4):836-50. · 7.67 Impact Factor
JTUA Laparoscopic Nephrectomy Tips QJTUA. 01/2009; 20(20):4-9.
Article: Retroperitoneoscopic nephrectomy has better perioperative outcomes than transperitoneal laparoscopic nephrectomy in obese patients[show abstract] [hide abstract]
ABSTRACT: ABSTRACT Objective:This retrospective, case-controlled study compares the operative outcomes of retroperitoneo-scopic nephrectomy (RN) and transperitoneal laparoscopic nephrectomy (TLN) in obese patients. Materials and Methods:A total of 202 operations, including 114 radical and 88 simple nephrectomies were identified from our prospectively collected institutional laparoscopic nephrectomy database. Patients were stratified into 3 groups according to the World Health Organization’s body mass index (BMI) classifi-cation: normal (Group 1-BMI <25 kg/m², n=68), overweight (Group 2-25 kg/m² ≤ BMI <30 kg/m², n=88) and obese (Group 3-BMI ≥30 kg/m², n=46). Furthermore, each group was divided into two subgroups according to the operation performed (RN or TLN). Perioperative parameters were compared statistically between the RN and TLN subgroups in all of the BMI-stratified categories. Results:The results for mean operative time (p<0.001, p=0.034 and p=0.005), estimated blood loss (p<0.001, p<0.001 and p=0.002) and length of hospital stay (p=0.005, p<0.001 and p<0.001) were all significantly in favor of RN in Groups 1, 2 and 3, respectively. The complication rate did not significantly differ between RN and TLN in the BMI-stratified groups. Conversely, the open conversion rate was significantly higher for TLN in Group 1 (p=0.024); this rate was similar for RN and TLN in Group 2 (p=0.22) and Group 3 (p=0.658). Conclusion:Retroperitoneoscopic nephrectomy has better perioperative outcomes in obese patients; these outcomes are similar to those seen in non-obese patients. However, both retroperitoneoscopic and transperi-toneal laparoscopic operations can be safely performed, with the same complication and open conversion rates, in obese patients. Key words:Nephrectomy; obesity; retroperitoneoscopic; transperitoneal laparoscopic.Turk Uroloji Dergisi 01/2012; 38(2):80-87.