Hand-assisted laparoscopic nephroureterectomy (HALNU): An assessment of the impact of obesity in 50 procedures

James A. Brown, Eric Chenven, Stephen Warwick Looney, Kelly M. Miller, Stephen E. Strup, Demetrius H. Bagley, Leonard G. Gomella

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective: The aims of this study was to review our experience with hand-assisted laparoscopic nephroureterectomy (HALNU) and to evaluate the impact of body-mass index (BMI) on outcomes. Methods: We retrospectively analyzed 50 HALNU patients. Twenty had body mass indices (BMIs) <25 (normal cohort), 18 had BMIs between 25 and 29.9 (overweight cohort), and 12 had BMIs ≥30 (obese cohort). Results: The cohorts had similar operative times: 349, 326, and 320 minutes, respectively. Most patients (38) underwent a total HAL distal ureterectomy, but 9 underwent an initial transurethral ureteral dissection (5 [25%], 2 [11%], and 2 [17%]). Five patients were converted to open and 1 had a planned open ureterectomy. The cystotomy was sutured closed in most but left open in 6 (3 [15%], 2 [11%], and 1 [8%]), and a stapled ureteral division was performed in 7 (3 [15%], 2 [11%], and 2 [17%]). Increased BMI was associated with delayed oral intake (P = 0.034). No significant cohort differences were observed for estimated blood loss (EBL), transfusion rate, complication rate, surgical margin status, distant metastases, or death rate. The obese cohort demonstrated trends toward increased hospitalization and bladder cancer recurrence (P = 0.083, P = 0.097). Patients with prior open surgery had longer hospitalizations (P = 0.024). Patients without prior surgery were more commonly alive with persistent disease (P = 0.027). EBL was greater for patients who had transurethral ureteral dissection (P = 0.030). Patients undergoing a stapled ureteral division had delayed oral intake, bowel function, and discharge (P = <0.001, P = 0.034, and P = 0.034). Conclusions: HALNU is an effective surgical treatment for patients with BMIs as great as 45.

Original languageEnglish (US)
Pages (from-to)61-68
Number of pages8
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques
Volume18
Issue number1
DOIs
StatePublished - Feb 1 2008
Externally publishedYes

Fingerprint

Hand
Obesity
Body Mass Index
Dissection
Hospitalization
Cystotomy
Operative Time
Urinary Bladder Neoplasms
Blood Transfusion
Neoplasm Metastasis
Recurrence
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

Hand-assisted laparoscopic nephroureterectomy (HALNU) : An assessment of the impact of obesity in 50 procedures. / Brown, James A.; Chenven, Eric; Looney, Stephen Warwick; Miller, Kelly M.; Strup, Stephen E.; Bagley, Demetrius H.; Gomella, Leonard G.

In: Journal of Laparoendoscopic and Advanced Surgical Techniques, Vol. 18, No. 1, 01.02.2008, p. 61-68.

Research output: Contribution to journalArticle

Brown, James A. ; Chenven, Eric ; Looney, Stephen Warwick ; Miller, Kelly M. ; Strup, Stephen E. ; Bagley, Demetrius H. ; Gomella, Leonard G. / Hand-assisted laparoscopic nephroureterectomy (HALNU) : An assessment of the impact of obesity in 50 procedures. In: Journal of Laparoendoscopic and Advanced Surgical Techniques. 2008 ; Vol. 18, No. 1. pp. 61-68.
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abstract = "Objective: The aims of this study was to review our experience with hand-assisted laparoscopic nephroureterectomy (HALNU) and to evaluate the impact of body-mass index (BMI) on outcomes. Methods: We retrospectively analyzed 50 HALNU patients. Twenty had body mass indices (BMIs) <25 (normal cohort), 18 had BMIs between 25 and 29.9 (overweight cohort), and 12 had BMIs ≥30 (obese cohort). Results: The cohorts had similar operative times: 349, 326, and 320 minutes, respectively. Most patients (38) underwent a total HAL distal ureterectomy, but 9 underwent an initial transurethral ureteral dissection (5 [25{\%}], 2 [11{\%}], and 2 [17{\%}]). Five patients were converted to open and 1 had a planned open ureterectomy. The cystotomy was sutured closed in most but left open in 6 (3 [15{\%}], 2 [11{\%}], and 1 [8{\%}]), and a stapled ureteral division was performed in 7 (3 [15{\%}], 2 [11{\%}], and 2 [17{\%}]). Increased BMI was associated with delayed oral intake (P = 0.034). No significant cohort differences were observed for estimated blood loss (EBL), transfusion rate, complication rate, surgical margin status, distant metastases, or death rate. The obese cohort demonstrated trends toward increased hospitalization and bladder cancer recurrence (P = 0.083, P = 0.097). Patients with prior open surgery had longer hospitalizations (P = 0.024). Patients without prior surgery were more commonly alive with persistent disease (P = 0.027). EBL was greater for patients who had transurethral ureteral dissection (P = 0.030). Patients undergoing a stapled ureteral division had delayed oral intake, bowel function, and discharge (P = <0.001, P = 0.034, and P = 0.034). Conclusions: HALNU is an effective surgical treatment for patients with BMIs as great as 45.",
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AU - Looney, Stephen Warwick

AU - Miller, Kelly M.

AU - Strup, Stephen E.

AU - Bagley, Demetrius H.

AU - Gomella, Leonard G.

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