Comparison of Open and Laparoscopic Nephrectomy in Obese and Nonobese Patients: Outcomes Stratified by Body Mass Index

Feder, Marc; Patel, Manoj; Melman, Arnold; Ghavamian, Reza; Hoenig, David M.

doi:10.1016/j.juro.2008.03.023

Cited by 46 publications

(28 citation statements)

References 12 publications

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“…Furthermore, laparoscopic radical nephrectomy is feasible in the overweight patient, and although technically more challenging, this approach may result in superior perioperative outcomes as compared with the open technique 47. Finally, centres of expertise have reported laparoscopic radical nephrectomies with renal vein and vena cava tumour thrombi, confirming the safety and feasibility of the technique 48–50.…”

Section: Surgical Treatment For Localized Rccmentioning

confidence: 83%

The Contemporary Role of Surgery in Kidney Cancer

2009

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The diagnosis and treatment of renal cell carcinoma (RCC) has been the subject of major changes since the late 1980s. Initially, surgery was the only treatment available, but more recently, systemic therapies have been developed, and their introduction has modified some of the surgical indications for RCC. In addition, refinements in surgical technique and the introduction of minimally invasive approaches have revolutionized patient care and bear the promise of even more improvements to come. This paper provides an up-to-date overview of recent developments in the surgical treatment of RCC.

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Section: Surgical Treatment For Localized Rccmentioning

confidence: 83%

The Contemporary Role of Surgery in Kidney Cancer

2009

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“…It is also evident, that the retroperitoneal approach showed some clinical advantages intraoperatively (i.e. shorter operative time) and postoperatively, especially in obese patients [21,22] . However, for the senior patient, the changes in hemodynamic functions found in the TPL and RPL surgery groups were generally similar.…”

Section: Discussionmentioning

confidence: 99%

Effects of Retroperitoneal or Transperitoneal Laparoscopic Surgery on Hemodynamic and Respiratory Function in Old Patients

Ji¹,

Zhang²,

Li³

et al. 2009

Urol Int

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Purpose: To compare the effects of retroperitoneal laparoscopic surgery (RPL) and transperitoneal laparoscopic surgery (TPL) on the hemodynamic and ventilatory functions in old patients. Methods: Thirty-two senior patients underwent either RPL or TPL. Swan-Ganz and radial artery catheters were placed to monitor hemodynamic functions. Artery blood samples were obtained to analyze ventilatory functions. Results: For hemodynamic changes in both TPL and RPL, central venous pressure, mean pulmonary arterial pressure and pulmonary capillary wedge pressure significantly increased 10 min after CO₂ insufflation and decreased to preanesthesia levels roughly 30 min after insufflation relief. For ventilatory functions, in both TPL and RPL, peak airway pressure, partial pressure of arterial carbon dioxide (PaCO₂), end-tidal carbon dioxide tension (PetCO₂), carbon dioxide output (VCO₂), and the difference between PaCO₂ and PetCO₂ (Pa-PetCO₂) all increased significantly 10 min after CO₂ insufflation and returned to the preanesthesia level 20 min after CO₂ desufflation. However, increments of PaCO₂, VCO₂ and Pa-PetCO₂ were significantly higher in RPL than in TPL, and did not return to the preanesthesia level until 30 min after CO₂ desufflation. Conclusion: For senior patients, TPL and RPL have similar effects on hemodynamic functions. However, RPL tends to cause much more change in the respiratory measurements.

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“…These studies suggest that laparoscopy can be performed safely and as feasibly as open surgery in obese patients. [21,22] Other comparative studies have highlighted similar complication and open conversion rates between obese and non-obese patients who have undergone laparoscopic nephrectomy despite the increased operative times and greater estimated blood loss seen in obese patients. [23][24][25] In general, the present study aimed to examine another issue related to LN in obese patients and to determine whether the retroperitoneoscopic or transperitoneal laparoscopic approach is better.…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneoscopic nephrectomy has better perioperative outcomes than transperitoneal laparoscopic nephrectomy in obese patients

Erdem

Şanlı

Tefik

et al. 2012

Turkish Journal of Urology

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Objective: This retrospective, case-controlled study compares the operative outcomes of retroperitoneoscopic 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) classification: 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 transperitoneal laparoscopic operations can be safely performed, with the same complication and open conversion rates, in obese patients. ÖZET Amaç: Bu retrospektif vaka-kontrol çalışmasında, obez hastalarda retroperitoneoskopik nefrektomi (RN) ve transperitoneal laparoskopik nefrektomi (TLN) operatif sonuçlar açısından karşılaştırıldı. Gereç ve Yöntem: Kurumsal laparoskopik nefrektomi veritabanından, 114'ü radikal ve 88'i basit toplam 202 operasyon belirlendi. Hastalar, Dünya Sağlık Örgütü'nün vücut kitle indeksi (VKİ) sınıflamasına göre 3 gruba ayrıldı; normal (Grup 1 -VKİ <25 kg/m², n=68), aşırı kilolu (Grup 2-25 kg/m² ≤ VKİ <30 kg/m², n=88) ve obez (Grup 3-VKİ ≥ 30 kg/m², n=46). Her grup, RN ve TLN operasyonlarına göre ileri iki altgruba ayrıldı. Perioperatif parametreler VKİ'ye göre sınıflandırılmış gruplarda, RN ve TLN arasında istatistiksel olarak karşılaştırıldı. Bulgular: Operasyon süresi (p<0.001, p= 0.034 and p= 0.005), tahmini kan kaybı (p<0.001, p<0.001 and p= 0.002) ve hastane yatış süresi (p= 0.005, p<0.001 and p<0.001) sırasıyla Grup 1, 2 ve 3 için RN lehine anlamlı bulundu. Komplikasyonlar VKİ'ye göre sınıflandırılmış gruplarda, RN ve TLN arasında anlamlı olarak farklı değildi. Buna karşın; açık operasyona geçiş oranları Grup 1'de TLN için anlamlı olarak artmış (p= 0.024) bulunurken Grup 2 (p= 0.22) ve Grup 3'te (p= 0.685) RN ve TLN arasında fark gözlenmedi.Sonuç: Obez hastalarda, retroperitoneoskopik nefrektomi o...

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Comparison of Open and Laparoscopic Nephrectomy in Obese and Nonobese Patients: Outcomes Stratified by Body Mass Index

Cited by 46 publications

References 12 publications

The Contemporary Role of Surgery in Kidney Cancer

The Contemporary Role of Surgery in Kidney Cancer

Effects of Retroperitoneal or Transperitoneal Laparoscopic Surgery on Hemodynamic and Respiratory Function in Old Patients

Retroperitoneoscopic nephrectomy has better perioperative outcomes than transperitoneal laparoscopic nephrectomy in obese patients

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