LAPAROSCOPIC RENAL AND ADRENAL SURGERY IN OBESE PATIENTS: COMPARISON TO OPEN SURGERY
1999; Lippincott Williams & Wilkins; Volume: 162; Issue: 3 Part 1 Linguagem: Inglês
10.1097/00005392-199909010-00005
ISSN1527-3792
AutoresSurena F. Matin, Inderbir S. Gill, THOMAS H.S. HSU, Gyung Tak Sung, Andrew C. Novick,
Tópico(s)Vascular anomalies and interventions
ResumoNo AccessJournal of UrologyClinical Urology: Original Articles1 Sep 1999LAPAROSCOPIC RENAL AND ADRENAL SURGERY IN OBESE PATIENTS: COMPARISON TO OPEN SURGERY SURENA FAZELI-MATIN, INDERBIR S. GILL, THOMAS H.S. HSU, GYUNG TAK SUNG, and ANDREW C. NOVICK SURENA FAZELI-MATINSURENA FAZELI-MATIN , INDERBIR S. GILLINDERBIR S. GILL , THOMAS H.S. HSUTHOMAS H.S. HSU , GYUNG TAK SUNGGYUNG TAK SUNG , and ANDREW C. NOVICKANDREW C. NOVICK View All Author Informationhttps://doi.org/10.1097/00005392-199909010-00005AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The efficacy and morbidity of laparoscopic renal and adrenal surgery in comparison to open surgery in obese patients are unknown. This retrospective study was performed to compare the outcome of laparoscopic versus open renal and adrenal surgery in the markedly and morbidly obese patient (body mass index 30 or greater). Materials and Methods: The study group comprised all obese patients undergoing laparoscopic renal and adrenal surgery (laparoscopic group) from August 1997 to February 1998 at our institution. The majority of procedures were performed using a retroperitoneoscopic approach via the flank. These patients were compared with all obese patients undergoing open renal and adrenal surgery (open group) from 1994 to 1998. Open group patients with factors precluding laparoscopic surgery were excluded from the study (mass greater than 10 cm., renal vein and/or inferior vena caval thrombus and extension outside Gerota's fascia). Results: There were 21 obese patients in each group and baseline parameters were comparable between groups. Median body mass index in the laparoscopic and open groups was 34 and 31, respectively. Median surgical time between the laparoscopic (210 minutes) and open (185) groups was comparable (p = 0.16). However, the laparoscopic group had decreased blood loss (100 versus 350 ml., p <0.001), quicker resumption of oral intake and ambulation (less than 1 versus 5 days, p <0.001), decreased narcotic analgesic requirements (12 versus 279 mg., p <0.001), shorter median hospital stay (less than 1 versus 5 days, p <0.001) and quicker convalescence (3 versus 9 weeks, p <0.001). There were 6 complications in 4 laparoscopic cases and 14 in 9 open surgery cases (p = 0.16). Conclusions: Markedly obese patients have an increased risk of complications from surgery, regardless of the approach. Our data suggest that laparoscopic renal and adrenal surgery is technically feasible in the markedly and morbidly obese patient, and compared with open surgery results in significantly decreased blood loss, quicker return of bowel function, less analgesic requirement, shorter convalescence and reduced hospital stay. 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Google Scholar From the Department of Urology, Section of Laparoscopic and Minimally Invasive Surgery and the Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Cleveland, Ohio(Gill) Requests for reprints: Department of Urology, A100, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, Ohio 44195.© 1999 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byGabr A, Elsayed E, Gdor Y, Roberts W and Wolf J (2018) Obesity and Morbid Obesity are Associated With a Greater Conversion Rate to Open Surgery for Standard but Not Hand Assisted Laparoscopic Radical NephrectomyJournal of Urology, VOL. 180, NO. 6, (2357-2362), Online publication date: 1-Dec-2008.Pareek G, Hedican S, Gee J, Bruskewitz R and Nakada S (2018) Meta-analysis of the Complications of Laparoscopic Renal Surgery: Comparison of Procedures and TechniquesJournal of Urology, VOL. 175, NO. 4, (1208-1213), Online publication date: 1-Apr-2006.Clayman R (2018) Hand-Assisted Laparoscopic Renal Surgery in the Morbidly and Profoundly ObeseJournal of Urology, VOL. 174, NO. 1, (175-175), Online publication date: 1-Jul-2005.ANAST J, STOLLER M, MENG M, MASTER V, MITCHELL J, BASSETT W and KANE C (2018) DIFFERENCES IN COMPLICATIONS AND OUTCOMES FOR OBESE PATIENTS UNDERGOING LAPAROSCOPIC RADICAL, PARTIAL OR SIMPLE NEPHRECTOMYJournal of Urology, VOL. 172, NO. 6 Part 1, (2287-2291), Online publication date: 1-Dec-2004.SIMON S, FERRIGNI R, NOVICKI D, LAMM D, SWANSON S and ANDREWS P (2018) Mayo Clinic Scottsdale Experience With Laparoscopic Nephron Sparing Surgery for Renal TumorsJournal of Urology, VOL. 169, NO. 6, (2059-2062), Online publication date: 1-Jun-2003.MERANEY A, SAMEE A and GILL I (2018) Vascular and Bowel Complications During Retroperitoneal Laparoscopic SurgeryJournal of Urology, VOL. 168, NO. 5, (1941-1944), Online publication date: 1-Nov-2002.GUAZZONI G, CESTARI A, MONTORSI F, LANZI R, NAVA L, CENTEMERO A and RIGATTI P (2018) EIGHT-YEAR EXPERIENCE WITH TRANSPERITONEAL LAPAROSCOPIC ADRENAL SURGERYJournal of Urology, VOL. 166, NO. 3, (820-824), Online publication date: 1-Sep-2001.GILL I (2018) THE CASE FOR LAPAROSCOPIC ADRENALECTOMYJournal of Urology, VOL. 166, NO. 2, (429-436), Online publication date: 1-Aug-2001.SALOMON L, SOULÉ M, MOULY P, SAINT F, CICCO A, OLSSON E, HOZNEK A, ANTIPHON P, CHOPIN D, PLANTE P and ABBOU C (2018) EXPERIENCE WITH RETROPERITONEAL LAPAROSCOPIC ADRENALECTOMY IN 115 PROCEDURESJournal of Urology, VOL. 166, NO. 1, (38-41), Online publication date: 1-Jul-2001. Volume 162Issue 3 Part 1September 1999Page: 665-669 Advertisement Copyright & Permissions© 1999 by American Urological Association, Inc.MetricsAuthor Information SURENA FAZELI-MATIN More articles by this author INDERBIR S. GILL More articles by this author THOMAS H.S. HSU More articles by this author GYUNG TAK SUNG More articles by this author ANDREW C. NOVICK More articles by this author Expand All Advertisement PDF downloadLoading ...
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