Matthew L Steinway1, Irma J Lengu, Edward E Cherullo, Lee E Ponsky. 1. Center for Urologic Oncology and Minimally Invasive Therapies, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio 44106-5046, USA.
Abstract
PURPOSE AND OBJECTIVE: Laparoscopic nephrectomy has become a standard of care for localized renal tumors. Several groups have demonstrated single-incision laparoscopic nephrectomy performed completely through the extraction site, including transumbilical, paramedian, and transvaginal incisions. The Pfannenstiel incision is a commonly used extraction site after laparoscopic radical nephrectomy. The advantages of this incision include improved cosmesis as well as decreased pain. We investigated the feasibility of performing a single-incision laparoscopic nephrectomy through a Pfannenstiel incision in a porcine model, because this is the extraction site of choice at our institution. MATERIALS AND METHODS: Bilateral laparoscopic nephrectomies were performed in five acute female swine through a GelPort inserted into a 4- to 6-cm incision comparable to the human Pfannenstiel incision. RESULTS: Nine of 10 attempted nephrectomies were completed successfully. One nephrectomy was aborted because of a renal capsule laceration from a retraction injury. Mean operative time was 70.6 minutes (range 49-120 min). Mean estimated blood loss was 29.4 mL (range 5-100 mL). CONCLUSIONS: Laparoscopic nephrectomy through a single Pfannenstiel incision is technically feasible in the porcine model. We anticipate incorporating this approach in humans, because we commonly use the Pfannenstiel incision as an extraction site.
PURPOSE AND OBJECTIVE: Laparoscopic nephrectomy has become a standard of care for localized renal tumors. Several groups have demonstrated single-incision laparoscopic nephrectomy performed completely through the extraction site, including transumbilical, paramedian, and transvaginal incisions. The Pfannenstiel incision is a commonly used extraction site after laparoscopic radical nephrectomy. The advantages of this incision include improved cosmesis as well as decreased pain. We investigated the feasibility of performing a single-incision laparoscopic nephrectomy through a Pfannenstiel incision in a porcine model, because this is the extraction site of choice at our institution. MATERIALS AND METHODS: Bilateral laparoscopic nephrectomies were performed in five acute female swine through a GelPort inserted into a 4- to 6-cm incision comparable to the human Pfannenstiel incision. RESULTS: Nine of 10 attempted nephrectomies were completed successfully. One nephrectomy was aborted because of a renal capsule laceration from a retraction injury. Mean operative time was 70.6 minutes (range 49-120 min). Mean estimated blood loss was 29.4 mL (range 5-100 mL). CONCLUSIONS: Laparoscopic nephrectomy through a single Pfannenstiel incision is technically feasible in the porcine model. We anticipate incorporating this approach in humans, because we commonly use the Pfannenstiel incision as an extraction site.
Authors: Tarik Amer; Rakesh Danny Biju; Rachael Hutton; Mohammed Alsawi; Omar Aboumarzouk; Rami Hasan; Ross Clark; Brian Little Journal: Cent European J Urol Date: 2015-09-26