Departments of Urology Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan.
BJU Int. 2012 Dec;110(11 Pt C):E980-4. doi: 10.1111/j.1464-410X.2012.11274.x. Epub 2012 May 29.
Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Obesity is a common and growing problem in industrialized countries, and metabolic syndrome has been the focus of much attention recently, particularly with respect to obesity. Obesity is thought to be a major factor influencing surgical complexity during abdominal surgery, including laparoscopic surgery. In this study, we focused on visceral obesity which has been recognized as the most important pathogenic factor in metabolic syndrome. We found that a high visceral fat area was a significant risk factor for a prolonged operating time. We believe that visceral obesity may greatly affect surgical complexity and may be a suitable index for predicting the degree of operating difficulty associated with laparoscopic nephrectomy.
• To examine the impact of visceral fat on surgical complexity in patients undergoing laparoscopic nephrectomy.
• We reviewed the medical records of 121 patients who underwent laparoscopic nephrectomy from 2006 to 2010 at our institution. • The total fat area, visceral fat area (VFA) and subcutaneous fat area were measured at the level of the umbilicus using computed tomography (CT). • To identify the type of obesity, we divided VFA into ≥ 100 cm(2) and <100 cm(2). A VFA ≥ 100 cm(2) was used as the definition of visceral obesity. • We evaluated the impact of the VFA on technical difficulties encountered during laparoscopic nephrectomy by measuring operating time.
• A significant correlation was observed between body mass index (BMI) and operating time (P < 0.001, r = 0.316) in the patients undergoing laparoscopic nephrectomy. • VFA was also significantly correlated with operating time (P < 0.001, r = 0.348), and the correlation coefficient of VFA was higher than that of BMI. • Multivariate analysis showed that a high VFA was an independent risk factor for prolonged operating time (P = 0.009, odds ratio; 3.70), whereas BMI was not found to be a risk factor.
• The present data indicate that measurement of VFA by CT is of benefit for predicting the technical difficulty associated with laparoscopic radical nephrectomy. • Visceral obesity, which is one factor involved in metabolic syndrome, has a greater impact than BMI on the complexity of laparoscopic radical nephrectomy.
• 探讨内脏脂肪对腹腔镜肾切除术患者手术复杂性的影响。
• 我们回顾了 2006 年至 2010 年在我院行腹腔镜肾切除术的 121 例患者的病历。• 使用计算机断层扫描（CT）在脐水平测量总脂肪面积、内脏脂肪面积（VFA）和皮下脂肪面积。• 为了确定肥胖的类型，我们将 VFA 分为≥100cm²和<100cm²。VFA≥100cm²被用作内脏肥胖的定义。• 通过测量手术时间来评估 VFA 对腹腔镜肾切除术中遇到的技术困难的影响。
• 行腹腔镜肾切除术的患者中，BMI 与手术时间呈显著相关（P<0.001，r=0.316）。• VFA 与手术时间也呈显著相关（P<0.001，r=0.348），VFA 的相关系数高于 BMI。• 多变量分析显示，高 VFA 是手术时间延长的独立危险因素（P=0.009，优势比；3.70），而 BMI 不是危险因素。
• 本研究数据表明，通过 CT 测量 VFA 有助于预测腹腔镜根治性肾切除术相关的技术难度。• 代谢综合征相关的一个因素内脏肥胖对腹腔镜根治性肾切除术的复杂性影响大于 BMI。
