Nayak Prasant, Dheeroo Dheeraj, Tarigopula Vivek, Mandal Swarnendu, Singh Kirti, Das Manoj, Tripathy Sambit
All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India.
Int Urol Nephrol. 2025 Apr 27. doi: 10.1007/s11255-025-04528-9.
Although laparoscopic radical nephrectomy (LRN) is the standard of care for large and complex malignant renal masses, the location of the incision for kidney retrieval remains a point of debate, and no clear-cut guidelines exist. This study aimed to compare the outcomes of kidney specimen retrieval after LRN using either a Pfannenstiel incision (PFN) or an iliac fossa incision (IFN).
This was an open-labelled, parallel-group, randomised trial. The calculated sample was 52 [26 = each arm]. The primary endpoint was the surgical site pain in the immediate postoperative period measured by the Universal Pain Assessment Tool, every fourth hour till 48 h. Secondary endpoints were total operative time, incision length, blood loss during specimen retrieval, length of postoperative hospital stay, wound site cosmesis [Manchester scar scale] at 3 months postoperatively, and wound complications between the groups in the early postoperative period.
Demographic characteristics were comparable in both groups. Pain scores demonstrated a significant difference in favour of the Pfannenstiel incision group, particularly at 12, 16, 20, 24, 36 and 40 h postoperatively. There were no significant differences between groups on the other parameters.
The PFN has significantly less operative site pain than IFN following LRN.
尽管腹腔镜根治性肾切除术（LRN）是治疗大型复杂恶性肾肿块的标准治疗方法，但肾脏取出切口的位置仍是一个有争议的问题，且尚无明确的指南。本研究旨在比较采用Pfannenstiel切口（PFN）或髂窝切口（IFN）进行LRN后肾脏标本取出的效果。
这是一项开放标签、平行组、随机试验。计算得出的样本量为52例[每组26例]。主要终点是术后即刻至48小时期间每4小时使用通用疼痛评估工具测量的手术部位疼痛。次要终点包括总手术时间、切口长度、标本取出过程中的失血量、术后住院时间、术后3个月时伤口部位的美容效果[曼彻斯特瘢痕量表]以及术后早期两组之间的伤口并发症。
两组的人口统计学特征具有可比性。疼痛评分显示Pfannenstiel切口组有显著差异，尤其是在术后12、16、20、24、36和40小时。其他参数在两组之间无显著差异。
LRN术后，PFN的手术部位疼痛明显少于IFN。
