Feasibility of laparoscopic partial nephrectomy in the obese patient and assessment of predictors of perioperative outcomes
Single-incision laparoscopic surgery (SILS) is safe and feasible for benign and malignant colorectal diseases. SILS offers several patient-related benefits over multiport laparoscopy. However, its use in obese patients has been limited from concerns of technical difficulty, oncologic compromise, and higher complication and conversion rates. Our objective was to evaluate the feasibility and efficacy of SILS for colectomy in obese patients. Review of a prospective database identified patients undergoing elective colectomy using SILS from 2009 to 2014. They were stratified into obese (BMI ≥ 30 kg/m2) and non-obese cohorts (BMI < 30 kg/m2) and then matched on patient characteristics, diagnosis, and operative procedure. Demographic and perioperative outcome data were evaluated. The primary outcome measures were operative time, length of stay (LOS), and conversion, complication, and readmission rates for each cohort. A total of 160 patients were evaluated—80 in each cohort. Patients were well matched in demographics, diagnosis, and procedure variables. The obese cohort had significantly higher BMI (p < 0.001) and ASA scores (p = 0.035). Operative time (176.9 ± 64.0 vs. 144.4 ± 47.2 min, p < 0.001) and estimated blood loss (89.0 ± 139.5 vs. 51.6 ± 38.0 ml, p < 0.001) were significantly higher in the obese. There were no significant differences in conversion rates (p = 0.682), final incision length (p = 0.088), LOS (p = 0.332), postoperative complications (p = 0.430), or readmissions (p = 1.000) in the obese versus non-obese. Further, in malignant cases, lymph nodes harvested (p = 0.757) and negative distal margins (p = 1.000) were comparable across cohorts. Single-incision laparoscopic colectomy in obese patients had significantly longer operative times, but comparable conversion rates, oncologic outcomes, lengths of stay, complication, and readmission rates as the non-obese cohorts. In the obese, where higher morbidity rates are typically associated with surgical outcomes, SILS may be the ideal platform to optimize outcomes in colorectal surgery. With additional operative time, the obese can realize the same clinical and quality benefits of minimally invasive surgery as the non-obese.