LAPAROSCOPIC COMPLICATIONS IN MARKEDLY OBESE UROLOGIC PATIENTS (A MULTIINSTITUTIONAL REVIEW)

Objectives. Significant obesity is considered to be a relative contrai ndication to laparoscopic surgery. This study reviews the complication s encountered in massively obese patients undergoing urologic laparosc opic surgery. Methods. Body mass index (BMI) was used as an objective index to indicate massive obesity. Eleven institutions compiled retros pective data on 125 patients having a BMI greater than 30. Procedures performed included 76 pelvic lymph node dissections, 14 nephrectomies, 7 bladder neck suspensions, and 28 miscellaneous procedures. Results. For the group as a whole, the mean BMI was 35.1 (range 30.1 to 57.2). Mean operative time was 202 minutes (range 60 to 480). Conversion to open surgery occurred in 15 of the 125 patients (12%). Complication ra tes (minor and major) were 22% (27 occurrences in 125 patients) intrao peratively and 26% (33 occurrences in 125 patients) postoperatively. T he major complications included 2 trocar injuries to abdominal wall ve ssels, 1 bladder injury, 3 peripheral nerve injuries, 1 dysrhythmia, 1 deep vein thrombosis, 1 wound seroma, 1 nephrocutaneous fistula, 1 in cisional hernia, and I death. Conclusions. In this review, complicatio n rates for urologic laparoscopic surgery on massively obese patients were higher than in the general population undergoing laparoscopic sur gery (0.3% to 21%).