ROBOTIC-ASSISTED LAPAROSCOPIC PROSTATECTOMY IN OVERWEIGHT AND OBESE PATIENTS ALBERT A. MIKHAIL, BENJAMIN R. STOCKTON, MARCELO A. ORVIETO, GARY W. CHIEN, EDWARD M. GONG, KEVIN C. ZORN, CHARLES B. BRENDLER, GREGORY P. ZAGAJA, AND ARIEH L. SHALHAV ABSTRACT Objectives. To assess outcomes of robotic laparoscopic radical prostatectomy (RLRP) in overweight and obese patients, defined as those with a body mass index (BMI) of 25 to 30 kg/m 2 and greater than 30 kg/m 2 , respectively. Methods. This was a nonrandomized study evaluating all of our RLRP patients. Patients were divided into three groups: BMI of 25 kg/m 2 or less (group 1), BMI greater than 25 kg/m 2 and less than 30 kg/m 2 (group 2), and BMI of 30 kg/m 2 or more (group 3). Patients were evaluated prospectively with the validated Rand 36-Item Health Survey (version 2) and with the University of California, Los Angeles Prostate Cancer Index questionnaire. Results. Between February 2003 and November 2004, 150 RLRPs were performed at our center. Average follow-up was 8 months. Groups 1, 2, and 3 had 39, 65, and 46 patients, respectively. Average BMIs for all three groups were statistically different (P 0.01). When compared with group 1, open conversion rates, hospital stay, positive margin, and complication rates were not statistically different for groups 2 or 3. Operative time (P 0.004) and estimated blood loss (P 0.03), however, were statistically greater for group 3 compared with group 1. Transfusion rate was highest in group 2 (P = 0.04 compared with group 1). Prostate weights were also statistically greater in groups 2 (P = 0.003) and 3 (P = 0.02) compared with group 1. Overall, BMI did not increase perioperative and postoperative morbidity. Conclusions. Robotic laparoscopic radical prostatectomy is safe in overweight and obese patients and might be the surgical management of choice in this subset of patients. Further long-term follow-up with more patients is required to verify this initial observation. UROLOGY 67: 774–779, 2006. © 2006 Elsevier Inc. P revious studies have shown increased technical difficulty and complication rate in obese pa- tients during open 1 and laparoscopic procedures. 2,3 Obesity is associated with an elevated risk of non– insulin-dependent diabetes mellitus, coronary ar- tery disease, and a predicted decline in overall life expectancy in the United States. 4,5 Obese patients might prove to be a challenge for the most experienced surgeon, particularly in the setting of an open radical retropubic prostatectomy (RRP). Anatomic challenges include a deeper and possibly narrowed true pelvis, combined with oc- casional exostosis of the pubic symphysis. Many surgeons might postpone surgical intervention un- til weight loss is achieved or refer patients to radi- ation oncology. In the laparoscopic field, these challenges might continue to hinder the surgeon’s ability to operate efficiently and accurately when performing a prostatectomy. 3,6 Literature evaluat- ing the limitations of robotic laparoscopic radical prostatectomy (RLRP) in this group of patients is sparse. Here, we report our experience with RLRP using the da Vinci Robotic 3-Arm System (Intuitive Surgical, Sunnyvale, Calif) in overweight and obese patients, compared with a normal-weight cohort. MATERIAL AND METHODS This was an institutional review board–approved, nonran- domized, prospective study of a series of RLRP in overweight and obese patients. Patients with a body mass index (BMI) greater than 25 kg/m 2 and less than 30 kg/m 2 were considered overweight. Patients with a BMI greater than 30 kg/m 2 were considered obese. All patients underwent RLRP by two sur- geons using a similar, previously described technique. 7 Heights From the Section of Urology, Department of Surgery, University of Chicago, Chicago, Illinois Reprint requests: Albert A. Mikhail, M.D., Department of Surgery, Section of Urology, University of Chicago, 5841 South Maryland Street, MC 6038, Chicago, IL 60637. E-mail: almikhail@yahoo. com Submitted: May 4, 2005, accepted (with revisions): October 26, 2005 ADULT UROLOGY © 2006 ELSEVIER INC. 0090-4295/06/$32.00 774 ALL RIGHTS RESERVED doi:10.1016/j.urology.2005.10.049