Impact of prostate size and body mass index on perioperative morbidity after laparoscopic radical prostatectomy.
OBJECTIVE
We prospectively evaluated the impact of body mass index (BMI) and prostate gland size on operative time, estimated blood loss (EBL) and hospital stay (LOS) in patients undergoing laparoscopic radical prostatectomy at our institution.


METHODS
A total of 70 consecutive laparoscopic radical prostatectomies were performed at our institution from May 2002 to April 2003. Patients who had pelvic lymphadenectomy were excluded. A total of 62 cases were available for analysis. Two cases were converted to open surgery. Perioperative data on each group were recorded, including patient age, height, weight, American Society of Anesthesiologists score, prostate specific antigen, operative time, EBL, time to regular diet and LOS. Pathology data, including specimen weight, Gleason score and the margin status, were reviewed. Patients were grouped into 3 categories based on obesity, as measured by BMI (25 or less, 26 to 29 and greater than 29 kg/m) and prostatic gland size (less than 30, 30 to 50 g, and greater than 50 gm). Furthermore, an analysis of our initial 20, middle 20 and last 22 cases was also performed.


RESULTS
Mean patient age was 63 years and mean American Society of Anesthesiologists score was 2.4. Mean operative time was 247 minutes and average EBL was 413 cc. The average LOS in all groups was 2.2 days. There were no statistically significant differences in operative parameters (operative time, EBL or LOS) among the ideal body weight (BMI 25 kg/m or less), overweight (BMI 26 to 29) and obese (BMI greater than 29) groups. The initial 20 cases, the second 20 and the last 22 had similar operative time, EBL and LOS. The surgical margin positive rate in our series was 17.7% for all stages. Of the patients 82% were completely dry at 6 months.


CONCLUSIONS
In our cohort of patient body mass index (25 or less, 26 to 29 and greater than 29 kg/m) did not have a significant impact on operative or postoperative morbidity. However, a positive correlation between prostate gland size (greater than 50 gm) and EBL approached but did not achieve statistical significance. Laparoscopic prostatectomy can be performed safely in obese patients and patients with a large prostate gland.
Singh
Amar
A
Department of Urology, State University of New York, Upstate Medical University, Syracuse, New York 13210, USA.
Fagin
Randy
R
Shah
Gaurang
G
Shekarriz
Bijan
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D012307:Risk Factors