Laparoscopic nephrectomy in the markedly obese living renal donor

Objectives. To determine whether laparoscopic living donor nephrectomy is s afe and efficacious in markedly obese renal donors. Methods. From 1996 to 1999, 431 laparoscopic living donor nephrectomies wer e performed, The markedly obese group consisted of 41 patients with a body mass index (BMI) greater than 35. Forty-one controls with a BMI less than 3 0 were matched to the obese donors by sex, age, race, and date of surgery. Results. The markedly obese and control groups were closely matched in sex, race, age, serum creatinine level, creatinine clearance, HLA match to reci pient, side of donated kidney, and experience level of the surgeons. The ob ese patients had a BMI range of 35.2 to 53.9 (mean 39.3), and the control p atients had a BMI range of 18.4 to 29.0 (mean 24.3). Donor operations in th e markedly obese were significantly longer by an average of 40 minutes. The greater intraoperative blood loss and longer extraction incision length se en in the markedly obese did not reach statistical significance. More and l arger laparoscopic ports were used in the markedly obese. Obese donors were more likely to require conversion from laparoscopic nephrectomy to open ne phrectomy than ideal-sized donors. The postoperative recovery of the gastro intestinal tract, hospitalization time, analgesic requirements, and total c omplications were equal in the two groups, although the obese donors' compl ications tended to be cardiopulmonary problems. The recipient graft functio n was equivalent between the two groups. Conclusions. Laparoscopic living donor nephrectomy is more difficult to per form in the markedly obese but is associated with an equivalent donor morbi dity and recipient renal outcome. UROLOGY 56: 926-929, 2000. (C) 2000, Else vier Science Inc.