title: A prospective comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy in the extremely obese patient.
abstract: OBJECTIVE
  To prospectively compare the outcomes of transperitoneal laparoscopic nephrectomy (TLN) and retroperitoneal LN (RLN) in extremely obese patients, as LN in such patients (body mass index, BMI >/= 40 kg/m(2)) is an accepted but technically challenging undertaking, and either approach to the kidney can be used.
  
  
  METHODS
  Between July 1998 and August 2005, 51 consecutive patients with extreme obesity had 53 LNs at our institution (13 TLN and 40 RLN). Peri-operative data were collected prospectively in a database approved by the Institutional Review Board.
  
  
  RESULTS
  There were no statistically significant differences between the two approaches for several variables, including baseline BMI (44 vs 45; P = 0.23), muscle-splitting extraction incision length (7.0 vs 7.7 cm; P = 0.53), and intraoperative complications (none vs 5%; P = 0.99). RLN tended to cause less estimated blood loss (EBL, 150 vs 100 mL; P = 0.31), a shorter operation (190 vs 180 min; P = 0.11), larger specimen weight (682 vs 938 g; P = 0.078), lower intraoperative open conversion rate (15% vs 0%; P = 0.06), and a shorter hospital stay (53.6 vs 37.5 h; P = 0.33), although none of these variables was statistically significant at P < 0.05.
  
  
  CONCLUSIONS
  In the extremely obese patient, RLN tended to have advantages in EBL, operative duration, specimen weight, open conversion rate, and duration of hospital stay. RLN provides direct access to the renal hilum, and avoids the pannus and voluminous intra-abdominal fat encountered during TLN. These data and our experience support RLN as the technique of choice for LN in the extremely obese patient.
authors.affiliation: Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Berglund
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
authors.forename: Denise
authors.initials: D
authors.lastname: Babineau
authors.forename: Mihir
authors.initials: M
authors.lastname: Desai
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D009767:Obesity, Morbid / Q000150:complications*; D011446:Prospective Studies; D016896:Treatment Outcome