Matin Surena F, Gill Inderbir S
Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Urology. 2003 Apr;61(4):830-2. doi: 10.1016/s0090-4295(02)02579-7.
To describe a simple modification of the Pfannenstiel incision for performing intact specimen extraction during retroperitoneal laparoscopic radical nephrectomy.
After retroperitoneal laparoscopic radical nephrectomy is completed, and the specimen is entrapped in a specimen retrieval bag, a 5 to 7-cm Pfannenstiel (transverse) skin incision is made over the symphysis pubis, lateralized slightly toward the side of surgery. A vertical incision is then made in the anterior rectus fascia near the lateral aspect of the ipsilateral rectus muscle, from the level of the pubic bone extending cephalad for approximately 5 to 7 cm. The transversalis fascia is then perforated near the level of the pubis to enter the pelvic extraperitoneal space, which is developed to the upper retroperitoneum. The drawstring of the closed bag is grasped, allowing delivery of the entrapped intact specimen through the modified Pfannenstiel incision.
More than 50 specimen extractions have been performed in this manner, with specimen weights ranging up to 1.7 kg, after retroperitoneoscopic radical nephrectomy. No complications specific to this incision and no postoperative hernias have developed, although follow-up was short. Our modification combines the advantage of a potentially less painful, non-muscle-cutting Pfannenstiel skin incision with the advantages of retroperitoneal access afforded by a Gibson fascial incision. Although it has been our initial subjective impression that the degree of comfort and cosmesis from this modified Pfannenstiel incision may be better than that after enlargement of the primary port site, a detailed comparison of these two approaches is required.
描述一种改良的耻骨上横切口，用于在腹膜后腹腔镜根治性肾切除术中完整取出标本。
腹膜后腹腔镜根治性肾切除术后，将标本装入标本回收袋，在耻骨联合上方做一个5至7厘米的耻骨上（横形）皮肤切口，稍偏向手术侧。然后在同侧腹直肌外侧附近的腹直肌前鞘做一个垂直切口，从耻骨水平向上延伸约5至7厘米。接着在耻骨水平附近穿透腹横筋膜进入盆腔腹膜外间隙，并向腹膜后上方扩展。抓住封闭袋的拉绳，通过改良的耻骨上横切口完整取出标本。
腹膜后腹腔镜根治性肾切除术后，已采用这种方法进行了50多次标本取出，标本重量达1.7千克。尽管随访时间较短，但未出现该切口特有的并发症，也未发生术后疝。我们的改良方法结合了耻骨上横切口潜在疼痛较轻、不切断肌肉的优点以及吉布森筋膜切口提供的腹膜后入路的优点。虽然我们最初的主观印象是，这种改良的耻骨上横切口在舒适度和美观度方面可能优于扩大原穿刺孔部位后的效果，但仍需要对这两种方法进行详细比较。
