title: Does body habitus of patients affect operative difficulty during retroperitoneal laparoscopic radical nephrectomy?
abstract: OBJECTIVE
  Because of the limited working space available during retroperitoneal laparoscopic radical nephrectomy (LRN), the body habitus of the patient is likely to affect the risk of operative difficulties. This study sought to determine whether anthropometric measurements based on CT and abdominal radiography could be used to predict operative difficulties during retroperitoneal LRN.
  
  
  METHODS
  Between August 2004 and January 2012, 96 consecutive patients with preoperative CT and abdominal radiography examinations underwent retroperitoneal LRN for a T(1) or T(2) stage renal tumor at our institution. The association between anthropometric measurements and demographics of patients and operative duration, estimated blood loss (EBL), and perioperative complications were retrospectively analyzed. Multivariate analysis was performed, and P<0.05 was considered significant.
  
  
  RESULTS
  Anterior perirenal fat distance (P=0.016) and distance from the 12th rib to the iliac crest (P=0.038) were independently associated with operative duration. Only anterior perirenal fat distance (P=0.001) was independently associated with EBL. No intraoperative complications and reoperations occurred. The occurrence or severity of postoperative complications was not significantly associated with anthropometric measurements. Body mass index ≥25.0 kg/m(2) was not significantly associated with operative difficulties.
  
  
  CONCLUSIONS
  The anterior perirenal fat distance and the distance from the 12th rib to the iliac crest can be used to predict operative difficulties during retroperitoneal LRN.
authors.affiliation: Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Akaihata
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Haga
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Yanagida
authors.forename: Ken
authors.initials: K
authors.lastname: Aikawa
authors.forename: Kei
authors.initials: K
authors.lastname: Ishibashi
authors.forename: Norio
authors.initials: N
authors.lastname: Takahashi
authors.forename: Souichiro
authors.initials: S
authors.lastname: Ogawa
authors.forename: Toshiki
authors.initials: T
authors.lastname: Oguro
authors.forename: Masao
authors.initials: M
authors.lastname: Kataoka
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kojima
mesh_terms: D000886:Anthropometry; D016063:Blood Loss, Surgical; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D011860:Radiography, Abdominal; D012187:Retroperitoneal Space / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed