Laparoscopic radical prostatectomy in obese patients: feasible or foolhardy?

More than 70% of men who are candidates for radical prostatectomy can be classified as either overweight or obese by body mass index. The role for laparoscopic radical prostatectomy (LRP) in treating these patients remains to be defined. A wealth of experience from bariatric surgery confirms that laparoscopic procedures can be performed successfully, even in the setting of morbid obesity, despite well-defined derangements in respiratory dynamics. Using the technical modifications outlined here, LRP can be performed safely and effectively in obese patients. Obesity raises the degree of difficulty for LRP, however, resulting in longer operative times and possibly a higher rate of open conversion. For this reason, surgeons early in their LRP experience are advised to avoid obese patients until they have become facile in the performance of LRP in normal-weight individuals.