Implementation of a Very Low Calorie Diet in Patients Undergoing Urologic Surgery: Room for Improvement?

Abstract

Introduction Several urologic surgeries, such as adrenalectomy, radical nephrectomy, thrombectomy, and partial nephrectomy—whether open, laparoscopic, or robotic—often require liver retraction and mobilization to achieve adequate exposure of critical structures. However, performing these procedures in morbidly obese patients (defined as having a body mass index of > 30 kg/m) is technically challenging and represents an increasing problem given alarming increasing rates in the US population. Aside from the comorbidities that increase perioperative risks in this patient population, additional technical difficulties are often encountered when performing intraabdominal urologic procedures. In particular, hepatomegaly, a common condition in obese patients, often limits the intraabdominal space available for performing right-sided procedures, and even the use of robotic technology does not necessarily overcome this technical challenge. Furthermore, traction of a fatty liver may increase the risk for liver trauma or bleeding. We present a thorough discussion of the implementation of a very low calorie diet (VLCD) to decrease hepatomegaly before anticipated urologic surgery.