Journal article
Hand-Assisted Laparoscopic Nephroureterectomy (HALNU): An Assessment of the Impact of Obesity in 50 Procedures
Journal of laparoendoscopic & advanced surgical techniques. Part A, Vol.18(1), pp.61-68
02/2008
DOI: 10.1089/lap.2006.0131
PMID: 18266577
Abstract
Objective: The aims of this study was to review our experience with hand-assisted laparoscopic nephroureterectomy (HALNU) and to evaluate the impact of body-mass index (BMI) on outcomes.
Methods: We retrospectively analyzed 50 HALNU patients. Twenty had body mass indices (BMIs) <25 (normal cohort), 18 had BMIs between 25 and 29.9 (overweight cohort), and 12 had BMIs >/=30 (obese cohort).
Results: The cohorts had similar operative times: 349, 326, and 320 minutes, respectively. Most patients (38) underwent a total HAL distal ureterectomy, but 9 underwent an initial transurethral ureteral dissection (5 [25%], 2 [11%], and 2 [17%]). Five patients were converted to open and 1 had a planned open ureterectomy. The cystotomy was sutured closed in most but left open in 6 (3 [15%], 2 [11%], and 1 [8%]), and a stapled ureteral division was performed in 7 (3 [15%], 2 [11%], and 2 [17%]). Increased BMI was associated with delayed oral intake (P = 0.034). No significant cohort differences were observed for estimated blood loss (EBL), transfusion rate, complication rate, surgical margin status, distant metastases, or death rate. The obese cohort demonstrated trends toward increased hospitalization and bladder cancer recurrence (P = 0.083, P = 0.097). Patients with prior open surgery had longer hospitalizations (P = 0.024). Patients without prior surgery were more commonly alive with persistent disease (P = 0.027). EBL was greater for patients who had transurethral ureteral dissection (P = 0.030). Patients undergoing a stapled ureteral division had delayed oral intake, bowel function, and discharge (P = <0.001, P = 0.034, and P = 0.034).
Conclusions: HALNU is an effective surgical treatment for patients with BMIs as great as 45.
Details
- Title: Subtitle
- Hand-Assisted Laparoscopic Nephroureterectomy (HALNU): An Assessment of the Impact of Obesity in 50 Procedures
- Creators
- James A Brown - Department of Surgery, Medical College of Georgia, Augusta, GeorgiaEric Chenven - Private Practice, Fort Lauderdale, FloridaStephen W Looney - Department of Biostatistics, Medical College of Georgia, Augusta, GeorgiaKelly M Miller - Department of Biostatistics, Medical College of Georgia, Augusta, GeorgiaStephen E Strup - Division of Urology, University of Kentucky, Lexington, KentuckyDemetrius H Bagley - Department of Urology, Thomas Jefferson University, Philadelphia, PennsylvaniaLeonard G Gomella - Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania
- Resource Type
- Journal article
- Publication Details
- Journal of laparoendoscopic & advanced surgical techniques. Part A, Vol.18(1), pp.61-68
- DOI
- 10.1089/lap.2006.0131
- PMID
- 18266577
- ISSN
- 1092-6429
- eISSN
- 1557-9034
- Language
- English
- Date published
- 02/2008
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Urology
- Record Identifier
- 9984051795002771
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