Intact Specimen Extraction in Laparoscopic Nephrectomy Procedures: Pfannenstiel Versus Expanded Port Site Incisions

Tisdale, Britton; Kapoor, Anil; Hussain, Abdullatif; Piercey, Kevin; Whelan, J. Paul

doi:10.1016/j.urology.2006.09.061

Cited by 49 publications

(45 citation statements)

References 16 publications

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“…This benefit is reinforced by the evidence that midline extraction sites typically employed in an EA are more likely in the long term to result in an incisional hernia compared to Pfannenstiel and off-midline extraction incisions [26,27]. Multiple studies have shown that using IA with a Pfannenstiel incision for extraction site resulted in a significantly shorter incision length when compared to EA specimen extraction incision [17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis

et al. 2015

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Background The use of laparoscopy for right hemicolectomy has gained popularity allowing the option of a totally laparoscopic intracorporeal anastomosis (IA) for intestinal reconstruction. This technique may alleviate some of the technical limitations that a surgeon faces with a laparoscopic-assisted extracorporeal anastomosis (EA). Results A total of 195 patients underwent laparoscopic right hemicolectomy over the study period, with 86 (44 %) patients receiving IA and 109 (56 %) patients receiving an EA. The most common indication for surgery in both groups was cancer: 56 (65 %) of IA cases and 57 (52 %) of EA cases. IA had a significantly higher rate of minor complications but no difference in serious complications compared to EA. Conversion to open resection was higher in EA. Using multivariate analysis to compare IA versus EA, there was no significant difference in length of stay, return of bowel function, risk of anastomotic leak, risk of intraabdominal abscess or risk of wound complications. Amongst cancer resections, there was no significant difference in the median number of lymph nodes harvested (18 LNs in IA group vs. 19 LNs in EA group, P > 0.05). There was also no significant difference in overall survival and disease-free survival at 5.7 years between the two groups. MethodsConclusions IA in laparoscopic right hemicolectomy is associated with similar postoperative and oncologic outcomes compared to EA. IA may possess advantages in terms of conversion and flexibility of specimen extraction, but this is counterbalanced by a higher incidence of minor complications. These findings suggest that IA represents a valid technique in the arsenal of the experienced colorectal surgeon without compromising outcomes.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis

et al. 2015

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“…With intact extraction, specimen removal can be achieved by trocar site extension, connecting existing trocar site incisions, or by incising prior abdominal scars or creating a new incision. Transverse abdominal incisions are commonly chosen by surgeons because they achieve good cosmetics with potentially less pain if compared to incisions of other orientations (9). The use of retrieval devices facilitates either technique as with the Endocatch (U.S. Surgical; norwalk, CT) for intact removal or the LapSac (Cook Urological; Spencer, In) for the morcellated one.…”

Section: Specimen Retrievalmentioning

confidence: 99%

“…Midline trocars are also associated with a higher incidence of this complication, probably due to the fact that these trocars are usually of larger size and are actively manipulated during the surgical procedure. Umbilical and midline trocars are also frequently used for organ retrieval, seriously influencing fascial tissue trauma and weakness, predisposing to hernia formation (37,39).…”

Section: Port-site Hernia Formationmentioning

confidence: 99%

The final stage of the laparoscopic procedure: exploring final steps

et al. 2012

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INTRODuCTIONUrologic surgery continues to evolve focusing efforts on adequate treatment of pathologic urologic conditions in a safe and minimally invasive manner (1).Laparoscopic surgery has well defined benefits for the patient and has, over time, become accepted as a standard of care access strategy for the management of benign and malignant Urologic diseases. Despite significant advances in laparoscopic technique and technologies, laparoscopic Urologic surgery remains technically demanding. Unlike open surgery, at the end of laparoscopic extirpative procedures, the Urologist is often faced with the additional challenges of specimen retrieval and extraction.Laparoscopic specimen entrapment and extraction occur at what is falsely considered the "end of the procedure". During open surgery, after the specimen has been mobilized, the specimen is Despite significant advances in laparoscopic technique and technologies, laparoscopic Urologic surgery remains technically demanding regarding various surgical steps including the challenge of specimen retrieval and extraction, whether to install a drainage system and the best option for wound closure. Laparoscopic specimen entrapment and extraction occurs at what is falsely considered the "end of the procedure". During open surgery, after the specimen has been mobilized, the specimen is simply lifted out of the larger incision which has been made to achieve the surgical objectives. In contrast, significant laparoscopic skill is required to entrap and safely extract laparoscopic specimens. Indeed, the Urologist and surgical team which are transitioning from open surgery may disregard this important part of the procedure which may lead to significant morbidity. As such, it is imperative that during laparoscopic procedures, the "end of the procedure" be strictly defined as the termination of skin closure and dressing placement. Taking a few minutes to focus on safe specimen entrapment and extraction will substantially reduce major morbidity. The following review focus on the technology and technique of specimen entrapment and extraction, on the matter of whether to install a drainage system of the abdominal cavity and the options for adequate closure of trocar site wounds. This article's primary objectives are to focus on how to minimize morbidity while maintain the advantages of a minimally invasive surgical approach.

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“…Advantages of the Pfannenstiel incision compared to vertical incisions include decreased pain, improved cosmesis (10)(11)(12), and better healing. The transverse suprapubic scar can be hidden with most types of clothing, including a bathing suit.…”

Section: Commentsmentioning

confidence: 99%

“…The transverse suprapubic scar can be hidden with most types of clothing, including a bathing suit. In addition, the Pfannenstiel incision may be associated with a decreased rate of incisional hernia (12). When Bird et al (13) analyzed a cohort of patients undergoing laparoscopic radical nephrectomy with intact specimen extraction through 3 different sites (lower quadrant site, umbilical site, and paramedian site), they found that the occurrence of incisional hernia was significantly associated with the paramedian extraction site.…”

Section: Commentsmentioning

confidence: 99%

Laparoendoscopic pfannenstiel nephrectomy using conventional laparoscopic instruments - preliminary experience

Branco¹,

Kondo²,

Stunitz³

et al. 2010

Int. braz j urol.

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Purpose: To confirm the feasibility of the laparoendoscopic Pfannenstiel nephrectomy using conventional laparoscopic instruments. Materials and Methods: Since March 2009, laparoscopic nephrectomy through a Pfannenstiel incision has been performed in selected patients in our service. The Veress needle was placed through the umbilicus which allowed carbon dioxide inflow. One 5 mm (or 10 mm) 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 10 mm in the midline, a 10 mm ipsilateral to the kidney to be removed (2 cm away from the middle one), and a 5 mm contralateral to the kidney to be removed (2 cm away from the middle one). The entire procedure was performed using conventional laparoscopic instruments. At the end of the surgery, trocars were removed and all three incisions were united into a single Pfannenstiel incision for specimen retrieval. Results: Five nephrectomies were performed following this technique: one atrophic kidney, one kidney donation, two renal cancers and one bilateral renal atrophy. Median operative time was 100 minutes and median intraoperative blood loss was 100 cc. No intraoperative complications occurred and no patients required blood transfusion. Median length of hospital stay was 1 day (range 1 to 2 days). Conclusions: The use of the Pfannenstiel incision for laparoscopic nephrectomy seems to be feasible even when using conventional laparoscopic instruments, and can be considered a potential alternative for traditional laparoscopic nephrectomy.

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Intact Specimen Extraction in Laparoscopic Nephrectomy Procedures: Pfannenstiel Versus Expanded Port Site Incisions

Cited by 49 publications

References 16 publications

Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis

Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis

The final stage of the laparoscopic procedure: exploring final steps

Laparoendoscopic pfannenstiel nephrectomy using conventional laparoscopic instruments - preliminary experience

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