Binsaleh Saleh, Madbouly Khaled, Matsumoto Edward D, Kapoor Anil
1 Division of Urology, Department of Surgery, Faculty of Medicine, King Saud University , Riyadh, Saudi Arabia .
2 Department of Urology, Prince Mohammed Bin Abdulaziz Hospital , Riyadh, Saudi Arabia .
J Endourol. 2015 Aug;29(8):913-8. doi: 10.1089/end.2014.0899. Epub 2015 May 11.
To compare intra- and postoperative outcome of patients undergoing laparoscopic radical nephrectomy with intact specimen extraction through a Pfannenstiel (PFN) transverse suprapubic or expanded port site (EPS) incision in a prospective randomized fashion.
Patients undergoing laparoscopic transperitoneal radical nephrectomies for suspected renal tumors were randomized for intact renal specimen extraction via a PFN or EPS incision. Operative, perioperative, 1 week, 6 weeks, and 6 months postoperative parameters were prospectively recorded and analyzed including specimen weight, size in maximum diameter, incision length, total operative time, extraction time, estimated blood loss, length of hospital stay, pain score in the postoperative holding area and on the first post operative day, narcotic consumption, time to fluid intake/full diet intake, unassisted ambulation, cosmesis, and wound-related complications. A postoperative quality-of-life questionnaire was also filled out by all the patients.
Our series included 51 patients: 26 in the PFN group and 25 in the EPS group. The two groups were similar in demographic characteristics and intraoperative and postoperative parameters apart from a longer PFN incision (P<0.00). First postoperative day pain score was significantly less in the PFN group than in the EPS group (P=0.023). Complication rate was less in the PFN group, although not statistically significant. Hospital stay was significantly shorter in the PFN than in the EPS group (P=0.01). Mean cosmesis and operative satisfaction scores at week 1, week 6, and 6 month visits were not significantly different between both groups. Compared with the EPS group, PFN group patients significantly will choose the same operation if they would do it again (P=0.004).
PFN incision has less morbidity, pain score, and hospital stay compared with EPS incision for intact specimen extraction after transperitoneal laparoscopic radical nephrectomy. Both incisions are associated with high operative satisfaction, good cosmesis, and a low rate of wound complications.
以前瞻性随机方式比较经Pfannenstiel（PFN）耻骨上横切口或扩大切口部位（EPS）完整取出标本的腹腔镜根治性肾切除术患者的术中和术后结果。
因疑似肾肿瘤接受腹腔镜经腹根治性肾切除术的患者被随机分为通过PFN或EPS切口完整取出肾标本。前瞻性记录并分析手术、围手术期、术后1周、6周和6个月的参数，包括标本重量、最大直径大小、切口长度、总手术时间、取出时间、估计失血量、住院时间、术后观察区和术后第一天的疼痛评分、麻醉药物用量、开始摄入液体/正常饮食的时间、自主行走情况、美观程度及伤口相关并发症。所有患者还填写了术后生活质量问卷。
我们的系列研究纳入了51例患者：PFN组26例，EPS组25例。除PFN切口较长外（P<0.00），两组在人口统计学特征以及术中和术后参数方面相似。PFN组术后第一天的疼痛评分显著低于EPS组（P=0.023）。PFN组的并发症发生率较低，尽管无统计学意义。PFN组的住院时间显著短于EPS组（P=0.01）。两组在术后第1周、第6周和6个月随访时的平均美观程度和手术满意度评分无显著差异。与EPS组相比，PFN组患者若再次手术，显著更愿意选择相同的手术方式（P=0.004）。
对于经腹腹腔镜根治性肾切除术后完整取出标本，PFN切口与EPS切口相比，发病率、疼痛评分和住院时间更低。两种切口均具有较高的手术满意度、良好的美观效果和较低的伤口并发症发生率。
