title: A Prospective Randomized Study of Pfannenstiel Versus Expanded Port Site Incision for Intact Specimen Extraction in Laparoscopic Radical Nephrectomy.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1 Division of Urology, Department of Surgery, Faculty of Medicine, King Saud University , Riyadh, Saudi Arabia .
authors.forename: Saleh
authors.initials: S
authors.lastname: Binsaleh
authors.affiliation: 2 Department of Urology, Prince Mohammed Bin Abdulaziz Hospital , Riyadh, Saudi Arabia .
authors.forename: Khaled
authors.initials: K
authors.lastname: Madbouly
authors.affiliation: 3 McMaster Institute of Urology, St. Joseph's Healthcare, McMaster University , Hamilton, Ontario, Canada .
authors.forename: Edward D
authors.initials: ED
authors.lastname: Matsumoto
authors.affiliation: 3 McMaster Institute of Urology, St. Joseph's Healthcare, McMaster University , Hamilton, Ontario, Canada .
authors.forename: Anil
authors.initials: A
authors.lastname: Kapoor
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D011184:Postoperative Period; D011446:Prospective Studies; D011788:Quality of Life