A Pfannenstiel single-site nephrectomy and nephroureterectomy: a practical application of laparoendoscopic single-site surgery.

OBJECTIVES: To present the initial clinical experience with laparoendoscopic single-site (LESS) radical nephrectomy and nephroureterectomy performed completely through a Pfannenstiel incision. METHODS: Two patients underwent a single-site nephrectomy and nephroureterectomy for the diagnosis of an enhancing renal parenchymal mass and a renal pelvic mass, respectively. In both cases, a 7.5-cm Pfannenstiel incision was made and GelPort was inserted. Trocars were placed through the access port, and nephrectomy was performed using standard and bariatric length laparoscopic instruments. Distal ureter was resected through the Pfannenstiel incision for nephroureterectomy. No additional ports were used as both procedures were completed via the Pfannenstiel approach. RESULTS: The procedures were completed in 187 and 409 minutes, respectively, without complication. Blood loss was estimated at 50 and 200 mL, respectively. Postoperatively, the patients required minimal analgesia. Patients were discharged on postoperative days 2 and 4, respectively. CONCLUSIONS: LESS nephrectomy and nephroureterectomy using only a Pfannenstiel incision are technically feasible and reproducible in human beings if performed by surgeons with standard laparoscopic skills. Using standard and bariatric length laparoscopic instruments, the procedures were performed without complication, with minimal blood loss and minimal variance from standard laparoscopic techniques. We anticipate that this approach can be incorporated by the urologist adept at laparoscopic surgery and provides a practical application of LESS surgery for extirpative procedures.

Laparoendoscopic single-site (LESS) nephrectomy through a Pfannenstiel incision: porcine model.

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.