Laparoscopic nephrectomy through a pfannenstiel incision

Abstract

Purpose: Laparoscopic urologic surgery is generally performed using three to six ports by transperitoneal or retroperitoneal access. Recent developments regarding laparoscopic surgery have been directed toward reducing the size or number of ports to achieve the goal of minimal invasive surgery, by mini-laparoscopy, natural orifices access and transumbilical approach. This video reports three cases of laparoscopic nephrectomies performed thorugh a Pfannenstiel incision using conventional laparoscopic trocars and instruments Materials and Methods: Since March 2009, laparoscopic nephrectomy through a Pfannenstiel incision has been proposed for selected patients in our service. Patient selection was determined by any situation, pathologic or not, for which laparoscopy was deemed appropriate as the standard of care in our practice. The Veress needle was placed through the umbilicus which allowed the carbon dioxide inflow. One 5mm (or 10mm) trocar was placed at the umbilicus for the laparoscope, to guide the placement of three trocars over the Pfannenstiel incision. Additional trocars were placed as follows: a 10mm in the midline, a 10mm ipsilateral to the kidney to be removed (two centimeters far from the middle one), and a 5mm contralateral to the kidney to be removed (two centimeters far from the middle one). The entire procedure was performed using conventional laparoscopic instruments. In the end of the surgery, trocars were removed and all three incisions were united into a single Pfannenstiel incision for the specimen retrieval. Results: Three nephrectomies were performed following this technique: one atrophic kidney, one kidney donation and one renal cancer. Median operative time was 96 minutes (ranging from 80 to 120 minutes) and median intraoperative blood loss was 116 cc (ranging from 50 to 150cc). No intraoperative complications occurred and no patients needed blood transfusion. Median length of hospital stay was 32 hours (ranging from 24 to 48 hours). Conclusion: The use of the Pfannenstiel incision for laparoscopic nephrectomy seems to be feasible even using conventional laparoscopic instruments, and can be considered a potential alternative for traditional laparoscopic nephrectomy.Int Braz J Urol. 2010; 36 (Video #4): 247_8 Available