title: A comparative study of open, laparoscopic and robotic partial nephrectomy in obese patients.
abstract: OBJECTIVE
  Partial nephrectomy is a standard intervention for the treatment of small renal tumors. Our study compares the outcomes of three different partial nephrectomy methods (open, laparoscopic and robotic assisted) in obese (≥30 Kg/m(2)) patients with renal tumors.
  
  
  METHODS
  Between 2005-2011, 66 obese patients had partial nephrectomy. Patients were divided into three groups according to intervention received: Open (n = 21), laparoscopic (n = 31) and robotic (n = 14). The outcome variables of blood loss, length of hospital stay, and complications were assessed.
  
  
  RESULTS
  Mean blood loss in the laparoscopic group (100 mls) was significantly less than open group (300 mls) and no difference between laparoscopic and robotic groups (150 mls). We observed a shorter median hospital stay in the laparoscopic group (two days) than open group (four days) and no difference between laparoscopic and robotic groups (three days). Three patients in the laparoscopic group had complications: Two grade II and one with grade III (based on Clavien-Dindo classification). Tumor location, pathology, grade, stage, patient gender, age, preoperative creatinine and postoperative creatinine were not different among the groups (P > 0.05). The mean tumor size in the laparoscopic group (2.70 cms) was significantly smaller than that of the open group (4.22 cm) (P < 0.05), but not statistically different from that of the robotic group (2.99 cm).
  
  
  CONCLUSIONS
  Our study demonstrates that in obese patients, both laparoscopic and robotic partial nephrectomy are associated with less blood loss than open partial nephrectomy. Second, the length of the hospital stay was not related to the type of utilized intervention.
authors.affiliation: Department of Urology, Ain Shams University, Cairo, Egypt.
authors.forename: Clairese M
authors.initials: CM
authors.lastname: Webb
authors.affiliation: Ain Shams University, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Kamel
authors.affiliation: Department of Urology, Ain Shams University, Cairo, Egypt.
authors.forename: Ehab
authors.initials: E
authors.lastname: Eltahawy
authors.affiliation: Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA ; Department of Public Health, National Liver Institute, Menoufiya University, Menuofiya, Egypt.
authors.forename: Mohammed F
authors.initials: MF
authors.lastname: Faramawi
authors.affiliation: Department of Urology, Ain Shams University, Cairo, Egypt.
authors.forename: Annashia L
authors.initials: AL
authors.lastname: Shera
authors.affiliation: Department of Urology, Ain Shams University, Cairo, Egypt.
authors.forename: Rodney
authors.initials: R
authors.lastname: Davis
authors.affiliation: Department of Urology, Ain Shams University, Cairo, Egypt.
authors.forename: Nabil
authors.initials: N
authors.lastname: Bissada
authors.affiliation: Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
authors.forename: Supriya
authors.initials: S
authors.lastname: Jadhav
keywords: Kidney neoplasms; minimally invasive; nephrectomy; obesity; surgical procedures
references.citation: J Urol. 2008 Jul;180(1):79-83
references.pmid: 18485408
references.citation: J Endourol. 2011 Mar;25(3):447-53
references.pmid: 21247335
references.citation: Can J Anaesth. 2012 Oct;59(10):974-96
references.pmid: 22833138
references.citation: J Endourol. 2013 Aug;27(8):1000-7
references.pmid: 23547917