Hand-assisted laparoscopic nephrectomy in morbidly obese patients

Area of Science:

• Urology
• Surgical Oncology
• Bariatric Surgery

Background:

• Obesity prevalence in the Czech Republic is 30% and rising, complicating surgical procedures.
• Morbid obesity (BMI >40 kg/m2) presents significant challenges in managing kidney cancer.
• Effective surgical strategies are needed for obese patients undergoing nephrectomy.

Purpose of the Study:

• To evaluate the safety and efficacy of hand-assisted laparoscopic nephrectomy (HALS) for kidney cancer in morbidly obese patients (BMI >40 kg/m2).
• To present the surgical technique and assess perioperative and oncological outcomes.

Main Methods:

• Retrospective analysis of seven morbidly obese patients (BMI >40 kg/m2) who underwent HALS nephrectomy.
• Evaluation of demographic data, perioperative course (surgery time, blood loss, hospital stay, complications), tumor characteristics, and postoperative follow-up.

Main Results:

• The study included 7 patients (2 female, 5 male) with a mean BMI of 40.3-50.1 kg/m2.
• Average surgery time was 73-98 minutes with minimal blood loss (20-450 ml).
• All patients had kidney cancer (48-110 mm); one experienced incisional hernia, and one died from metastatic disease 9 months post-surgery. Tumor-free follow-up ranged from 1-5 years.

Conclusions:

• Hand-assisted laparoscopic nephrectomy (HALS) is a suitable and safe surgical technique for kidney cancer in morbidly obese patients.
• HALS nephrectomy demonstrates acceptable surgical and oncological results in this challenging patient group.
• The technique facilitates complex procedures, improving outcomes for obese individuals with kidney cancer.