A comparative study of open, laparoscopic and robotic partial nephrectomy in obese patients.

As the prevalence of obesity and metabolic syndrome continues to rise, more obese patients are being considered for minimally invasive surgery.[1] For novice surgeons, obesity can be considered a relative contraindication to laparoscopy, as excess adipose tissue can hinder the procedure by significantly modifying the perception of anatomy and reducing the effective operative field.[1] Obesity also portends a risk factors for renal cell carcinoma.[2] Partial nephrectomy is proven to provide equivalent oncological control to radical nephrectomy.[3] In recent times, partial nephrectomy was adopted as the standard of care for renal masses that are <4 cm in diameter,[4] and some tumors that are between 4 and 7 cm in diameter.[456] Laparoscopic partial nephrectomy (LPN) has been shown to be equivalent oncologically to open partial nephrectomy with some centers demonstrating lower blood loss and length of hospital stay after surgery.[67] The advanced laparoscopic skills required by LPN to accomplish tasks of tumor resection and renal reconstruction using intracorporeal suturing prevented the widespread application of the technique.[4] Warm ischemia time in LPN exceeded, in many instances, the acceptable maximum limit of 30 min even in the hand of experts.[7] Since the introduction of first robotic partial nephrectomy by Gettman et al. in 2004, the robotic technique was popularized.[7] Early studies of robotic partial nephrectomy failed to find tangible advantages to a robot-assisted approach and was even criticized for incurring more cost to the procedure.[78] However, over the past 5 years, several refinements to the technique have been introduced, and subsequently robotic partial nephrectomy has become a reasonable alternative to laparoscopic and open nephron-sparing techniques.[8] This is, to the best of our knowledge, the first study that compares between the outcomes of the three technique of partial nephrectomy, the open, the laparoscopic and robotic in obese patient population.