Impact Of Aderent Perirenal Fat On Retroperitoneal Laparoscopic Partial Nephrectomy

Objective: The aderent perirenal fat(APF)sticking to renal parenchyma makes it difficult to dissect and expose the tumor.Our objective was to evaluate the impact of aderent perirenal fat on retroperitoneal laparoscopic partial nephrectomy(RLPN).Methods: We analysed the data of 52 patients who underwent RLPN for a small renal tumor in the Second Hospital of Hebei Medical University,Department of Urology during the September 2013 to December 2015.The patients was divided into two groups according the presence of APF,through the preoperative computed tomography imaging,operation video,and operation records.APF was found in 24 patients,18 males and 6 females,age from 33 to 80,average 59.25±11.03;Body Mass Index(BMI): 20.32-32.87kg/m2,average 26.70±3.33kg/m2.No APF included 28 patients,13 males and 15 females,age from 28 to 78,average 49.71±11.86;BMI: 15.83-35.64kg/m2,average 25.65±4.01kg/m2.Collected data included patients' age,gender,BMI,history of hypertension,history of diabetes,American Society of Anesthesiologists score(ASA),intra-abdominal fat(IAF),tumor size,R.E.N.A.L.Nephrometry score(RNS),operative time,warm ischaemia time(WIT),estimated blood loss(EBL),and length of hospital stay.Results: Between the two groups,the BMI,tumor size,WIT,length of hospital stay were similar(26.70±3.33kg/m2 vs25.65±4.01kg/m2,3.53±1.21 cm vs3.64±1.05 cm,27.17±7.55 min vs25.21±5.64 min,12.54±4.06 d vs10.61±3.70 d,p>0.05),as well as the ASA and RNS.APF patients were older(59.25±11.03 y vs49.71±11.86 y,p=0.004).There were a high proportion of men(75.00% vs46.4%,p=0.036),patients with hypertension(62.5% vs28.6%,p=0.014),and patients with diabetes(41.7% vs14.3%,p=0.026).In the APF group,IAF was more(2.02±0.47 cm vs1.35±0.66 cm,p<0.001),operative time was longer(146.08±45.45 min vs119.32±28.83 min,p=0.017),and EBL was higher(82.92±45.73 ml vs51.79±25.10 ml,p=0.005).Conclusion: The adherent preirenal fat sticking renal results in a longer operative time and a higher EBL,but has no influences on the WIT and length of hospital stay.APF makes it difficult to expose the tumour,not to remove it.