title: Comparison of different extraction sites used during laparoscopic radical nephrectomy.
abstract: OBJECTIVE
  Laparoscopic radical nephrectomy is commonly performed for renal tumors that are not amenable to nephron sparing treatment. A number of techniques for intact specimen extraction are used. The development of incisional hernias from the extraction site is a known but infrequent delayed complication. We analyzed different extraction sites and risk factors for such hernias.
  
  
  METHODS
  We retrospectively analyzed a cohort of patients undergoing laparoscopic radical nephrectomy with intact specimen extraction through 3 sites. Patients and operation specific parameters were included with particular attention to factors predisposing patients to incisional hernia, including chronic obstructive pulmonary disease, diabetes mellitus, chronic steroid use and a high body mass index.
  
  
  RESULTS
  A total of 181 nephrectomies were performed in 175 patients and 175 kidneys (96.7%) had malignancy. Mean tumor size was 4.9 cm. Mean followup was 28.8 months. Extraction was done from a lower quadrant site in 55 patients (31.4%), from the umbilical site in 58 (33.2%) and from a paramedian site in 62 (35.4%). Patients with paramedian and lower quadrant extraction sites were older (p = 0.016), and had a higher body mass index (p = 0.001) and greater specimen weight (p = 0.003). In 4 patients an incisional hernia developed. An incisional hernia was significantly associated with the paramedian extraction site (p = 0.015).
  
  
  CONCLUSIONS
  Incisional hernias may occur as a delayed complication of laparoscopic radical nephrectomy. This complication most commonly develops at the extraction site. In patients with a high body mass index using a paramedian extraction site is a significant risk factor for incisional hernia formation.
authors.affiliation: Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA.
authors.forename: Vincent G
authors.initials: VG
authors.lastname: Bird
authors.forename: Jason K
authors.initials: JK
authors.lastname: Au
authors.forename: Yekutiel
authors.initials: Y
authors.lastname: Sandman
authors.forename: Rosely
authors.initials: R
authors.lastname: De Los Santos
authors.forename: Rajnikanth
authors.initials: R
authors.lastname: Ayyathurai
authors.forename: John M
authors.initials: JM
authors.lastname: Shields
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006555:Hernia, Ventral / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies