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Related Concept Videos

Drug Dosing: Obese Patients01:21

Drug Dosing: Obese Patients

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In the United States, obesity is a prominent concern. It is linked to heightened mortality rates due to increased occurrences of conditions such as hypertension, atherosclerosis, coronary artery disease, and diabetes compared to nonobese individuals. A patient is classified as obese if their actual body weight surpasses the ideal or desirable body weight by 20%, based on Metropolitan Life Insurance Company data. Ideal body weights consider average weights and heights for males and females...
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Pharmacokinetics in Obese Patients: Drug Absorption and Distribution01:25

Pharmacokinetics in Obese Patients: Drug Absorption and Distribution

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Obesity significantly alters the pharmacokinetic processes of drug absorption and distribution, presenting unique challenges in medical treatment. The increased fat tissue and decreased lean muscle in obese individuals can significantly affect how drugs are absorbed into the body and distributed across different tissues. This alteration can lead to variances in the effectiveness and safety of medications, necessitating adjustments in dosing or drug selection for obese patients.One notable...
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Pharmacokinetics in Obese Patients: Drug Metabolism and Excretion01:20

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Drug metabolism, a critical process in the liver, involves two primary phases: Phase I reactions and Phase II conjugation. Obesity introduces significant alterations in this metabolic process, primarily due to fatty infiltration of the liver, leading to conditions such as nonalcoholic fatty liver disease (NAFLD). This condition can modify the activities of both Phase I and II enzymes, impacting how drugs are metabolized in obese patients.Phase I metabolism sees variable effects across...
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Obesity01:24

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The Body Mass Index (BMI) is a numerical value derived from a person's weight and height, used to categorize individuals into weight ranges. It is calculated using the formula: weight in kilograms divided by height in meters squared. Obesity is a health condition characterized by excessive accumulation of adipose tissue that poses health risks, often diagnosed with a BMI ≥ 30. This excess fat storage occurs when surplus dietary calories are converted into triglycerides and stored in...
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Mixtures of Gases: Dalton's Law of Partial Pressures and Mole Fractions03:03

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Unless individual gases chemically react with each other, the individual gases in a mixture of gases do not affect each other’s pressure. Each gas in a mixture exerts the same pressure that it would exert if it were present alone in the container. The pressure exerted by each individual gas in a mixture is called its partial pressure.
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Dalton's Law of Partial Pressure01:11

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The partial pressure of a gas is a measure of the thermodynamic activity of the gas's molecules. The pressure that a gas would create if it occupied the total volume available is called the gas's partial pressure. If two or more gases are mixed together in a container, the molecules move randomly and collide with each other, causing them to reach thermal equilibrium. When the gases have the same temperature, their molecules have the same average kinetic energy. Thus, each gas obeys the...
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Retroperitoneal Robot-Assisted Partial Nephrectomy in Obese Patients.

Manar Malki1, Joanne Oakley1, Muddassar Hussain1

  • 1Frimley Renal Cancer Centre, Frimley Park Hospital, Frimley Health Foundation Trust, Surrey, United Kingdom.

Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
|May 30, 2019
PubMed
Summary

Retroperitoneal robotic-assisted partial nephrectomy (RAPN) is a feasible option for obese patients, offering good surgical access for nonanterior renal masses. This approach demonstrates reduced blood loss and shorter operative and ischemia times compared to transperitoneal RAPN.

Keywords:
high BMInephron sparing surgeryobesepartial nephrectomyrenal cell cancer

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Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Robotic Surgery

Background:

  • Obesity presents surgical challenges, particularly in renal procedures.
  • Robotic-assisted partial nephrectomy (RAPN) has emerged as a minimally invasive option for kidney tumor treatment.

Purpose of the Study:

  • To evaluate the feasibility and outcomes of retroperitoneal robotic-assisted partial nephrectomy (RAPN) in patients with a high body mass index (BMI).

Main Methods:

  • Retrospective review of 110 retroperitoneal RAPN procedures in patients with BMI ≥30 kg/m² between April 2012 and December 2018.
  • Analysis of demographic, operative, perioperative, and postoperative data, including complications and histology.

Main Results:

  • Median BMI was 33.1 kg/m². Median operative time was 130 minutes with a median warm ischemia time of 22.0 minutes.
  • Median estimated blood loss was 30 mL; 2.7% of cases required conversion to open surgery due to bleeding.
  • Postoperative complications were generally low (Clavien-Dindo grade 2 or 3a), with a median length of stay of 1 day.

Conclusions:

  • Retroperitoneal RAPN is a viable and safe procedure for obese patients, providing effective surgical access for nonanterior renal masses.
  • The retroperitoneal approach in RAPN appears to offer advantages in blood loss, surgical time, and warm ischemia time compared to transperitoneal methods.