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The prevalence of obesity is increasing worldwide and has been labeled epidemic in the United States, where more than one-third of the population is overweight. In addition to higher rates of chronic diseases, obese people face increased risks for complications during and after surgery. For those who require surgery for kidney cancer, laparoscopic techniques may reduce these complications.
Laparoscopy involves making small incisions in the surgical area, rather than cutting open the body cavity and inserting a device that allows surgeons to view the abdominal cavity.
Researchers at the Cleveland Clinic Foundation in Ohio compared the results of laparoscopic surgery and open surgery in patients who were having their kidneys or adrenal glands removed due to cancer. All the patients had a body index (weight in kilograms divided by height in meters) of at least 30, which is the definition of clinical obesity. There were no clinical differences between the two groups before surgery.
Compared to the 21 patients who had open surgery, the 21 patients undergoing laparoscopy had less blood loss and post-operative pain, as well as a shorter hospital stay (one vs. five days), recovery, and convalescence (three vs. eight and one-half weeks). More open surgery patients required blood transfusion during the operation than laparoscopy patients. There was no difference between the two groups in the frequency of major complications or in the effectiveness of the surgery in removing cancerous tissue.
Reporting recently in "The Journal of Urology," the researchers concluded that "laparoscopic renal and adrenal surgery is feasible in markedly obese patients and appears to be as efficacious as traditional open surgery." They also noted that laparoscopic surgery in these cases led to "significantly lower rates of blood loss, less postoperative narcotic use and a quicker return of bowel function… [and] hospital stay and convalescence were significantly reduced."
Surveys have found that almost half of urology centers that do laparoscopy consider this procedure inappropriate for obese patients. The researchers concluded, in fact, that for minimally invasive surgery of the kidney and adrenal gland, laparoscopy is actually the preferred technique and called for more research in larger groups of patients to confirm their findings.