Impact of Obesity on Complications of Laparoscopic Simple or Radical Nephrectomy

Abstract

Objective: To determine the impact of obesity on complications in laparoscopic simple or radical nephrectomy.

Patients and methods: The medical files of 215 patients who underwent laparoscopic simple or radical nephrectomy in our center between 2004 and 2014 were reviewed. A body mass index of 30 kg/m² was used to divide the patients into obese and non-obese groups. Pre-operative data and intra- and post-operative complications were compared between the 2 groups.

Results: There were respectively 163 and 52 patients in the non-obese and obese groups, which were comparable in terms of age, sex, and history of surgery. In the obese group, operative specimens were significantly heavier (772 vs. 534 g in the non-obese group; p = 0.005) and durations of surgery was significantly longer (244 vs. 216 minutes; p = 0.003). However no significant differences were found between the 2 groups for duration of hospitalization, surgical conversion, estimated blood loss, or intra- or post-operative complications.

Conclusion: Laparoscopic simple or radical nephrectomy is technically feasible in obese patients but the surgery may take more time, notably due to dissection difficulties. Our results showed that the risk of intra- and post-operative complications is not higher in obese patients compared to non-obese patients, except for a possible, but statistically undemonstrated, higher risk of abdominal wall complications, and that the laparoscopic approach should be the preferred technique in patients with high body mass index.

Keywords: Complications; Nephrectomy; Obesity.

Fig. 1

Changes in port placement in a patient with a BMI of 39 kg/m² for right nephrectomy. O: optical trocar, C1: operator trocar for the right hand, A: trocar for the assistant, F: trocar for the liver. C1′, C2′ and O' are the modified locations for an obese patient.