title: Hand-assisted laparoscopic renal surgery in the morbidly and profoundly obese.
abstract: OBJECTIVE
  Obesity has been regarded as a relative contraindication to standard laparoscopic procedures. We evaluated the impact of morbid (body mass index [BMI] >30 kg/m2) and profound (BMI > 40 kg/m2) obesity on the results of hand-assisted laparoscopic renal surgery (HALRS).
  
  
  METHODS
  From September 1996 until October 2002, a total of 30 patients among 105 on whom HALRS was performed at our institution were morbidly obese, with a mean BMI of 35.8 kg/m2 (range 30.3-52.3 kg/m2). Eight patients were noted to have profound obesity, with a mean BMI of 44 kg/m2 (range 40.1-52.3 kg/m2). The HALRS procedures included radical nephrectomy in 23 patients, simple nephrectomy in 4, nephroureterectomy in 2, and partial nephrectomy in 1. At least one additional significant comorbidity was noted in 70% of these patients. We retrospectively evaluated the intraoperative and postoperative outcomes in this group of obese patients.
  
  
  RESULTS
  All procedures were performed successfully without the need for open conversion. The mean operative time was 262 minutes (range 125-361 minutes), and the mean estimated blood loss was 217 mL (range 50-600 mL). No transfusions or intraoperative complications occurred. The mean hospital stay was 4.1 days (range 2-13 days). There were 7 minor postoperative complications including ileus (N = 5), wound cellulitis (1), and urinary retention (1). No complications occurred in the profoundly obese patient subgroup.
  
  
  CONCLUSIONS
  Hand-assisted laparoscopic renal surgery is safe and effective in the morbidly and profoundly obese patient.
authors.affiliation: Department of Surgery, Division of Urology, University of Wisconsin, Madison, Wisconsin 53792, USA. hedican@surgery.wisc.edu
authors.forename: Sean P
authors.initials: SP
authors.lastname: Hedican
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Moon
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Lowry
authors.forename: Stephen Y
authors.initials: SY
authors.lastname: Nakada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007674:Kidney Diseases / Q000453:epidemiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D009767:Obesity, Morbid / Q000150:complications* / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery