Article

A prospective comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy in the extremely obese patient.

Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
BJU International (impact factor: 2.84). 05/2007; 99(4):871-4. DOI:10.1111/j.1464-410X.2006.06696.x
Source: PubMed

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.

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    Article: Complications of laparoscopic surgery for renal masses: prevention, management, and comparison with the open experience.
    Alberto Breda, Antonio Finelli, Gunter Janetschek, Francesco Porpiglia, Francesco Montorsi
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    Article: Retroperitoneoscopic nephrectomy has better perioperative outcomes than transperitoneal laparoscopic nephrectomy in obese patients
    Erdem S, Sanli O, Tefik T, Oktar T, Ortac M, Karadeniz M, Ozcan F
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    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.

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Keywords

51 consecutive patients
 
body mass index
 
estimated blood loss
 
experience support RLN
 
Institutional Review Board
 
larger specimen weight
 
lower intraoperative open conversion rate
 
muscle-splitting extraction incision length
 
obese patients
 
open conversion rate
 
Peri-operative data
 
renal hilum
 
retroperitoneal LN
 
shorter hospital
 
shorter operation
 
specimen weight
 
statistically significant differences
 
transperitoneal laparoscopic nephrectomy
 
two approaches
 
voluminous intra-abdominal fat