title: Laparoendoscopic single-site (LESS) nephrectomy through a Pfannenstiel incision: porcine model.
abstract: 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.
  
  
  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.
authors: Center for Urologic Oncology and Minimally Invasive Therapies, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio 44106-5046, USA.
authors: Matthew L
authors: ML
authors: Steinway
authors: Irma J
authors: IJ
authors: Lengu
authors: Edward E
authors: EE
authors: Cherullo
authors: Lee E
authors: LE
authors: Ponsky
mesh_terms: D000818:Animals; D005260:Female; D007668:Kidney / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D023421:Models, Animal; D009392:Nephrectomy / Q000379:methods*; D013525:Surgical Instruments; D034421:Sus scrofa / Q000601:surgery*