title: Laparoscopic nephrectomy - Pfannenstiel or expanded port site specimen extraction: a systematic review and meta-analysis.
abstract: BACKGROUND
  To anaylse the current evidence regarding the safety, feasibility and advantages of intact specimen extraction via various extraction sites after conventional laparoscopic nephrectomy (LN).
  
  
  METHODS
  A comprehensive literature search was performed identifying studies evaluating outcomes from Pfannenstiel (PFN) versus extended port site (EPS) extraction sites, after conventional laparoscopic nephrectomy/nephroureterectomy (LRN/LNU) and donor nephrectomy (LDN). Outcome measures included procedure duration, incision length, duration of inpatient stay, analgesic requirements, complications and warm ischemia time (for donor nephrectomy cases).
  
  
  RESULTS
  This systematic review of five comparative studies found no significant difference in morbidity, wound length, wound complications or opioid consumption across all studies. Inpatient stay (p = 0.03) and estimated blood loss (p = 0.03) were significantly less in favour of a PFN extraction site. When comparing radical nephrectomy cases alone, the PFN group had a shorter procedure time (NS), less estimated blood loss (p = 0.04), shorter inpatient stay (p <0.05), significantly less morphine use (p <0.006) and fewer wound complications.
  
  
  CONCLUSIONS
  This review demonstrates the viability of retrieving a nephrectomy specimen/graft through a PFN incision in relation to the benefits of cosmesis and reduced pain. As reported in several trials, morbidity is not significantly increased and key outcome measures, such as duration of inpatient stay, pain scores, complications, analgesic requirements and time taken to return to normal activities, remain non-inferior. This study is limited by the small number of generally low quality studies available for analysis. Further well-constructed randomised controlled trials are needed to shed more light on this subject area.
authors.affiliation: Ayr Urology Department, Ayr, United Kingdom.
authors.forename: Tarik
authors.initials: T
authors.lastname: Amer
authors.affiliation: Ayr Urology Department, Ayr, United Kingdom.
authors.forename: Rakesh Danny
authors.initials: RD
authors.lastname: Biju
authors.affiliation: Ayr Urology Department, Ayr, United Kingdom.
authors.forename: Rachael
authors.initials: R
authors.lastname: Hutton
authors.affiliation: Ayr Urology Department, Ayr, United Kingdom.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alsawi
authors.affiliation: Department of Urology, Royal Gwent Hospital, Newport, United Kingdom.
authors.forename: Omar
authors.initials: O
authors.lastname: Aboumarzouk
authors.affiliation: Ayr Urology Department, Ayr, United Kingdom.
authors.forename: Rami
authors.initials: R
authors.lastname: Hasan
authors.affiliation: Ayr Urology Department, Ayr, United Kingdom.
authors.forename: Ross
authors.initials: R
authors.lastname: Clark
authors.affiliation: Ayr Urology Department, Ayr, United Kingdom.
authors.forename: Brian
authors.initials: B
authors.lastname: Little
keywords: Pfannenstiel nephrectomy; laparoscopic nephrectomy extraction; pfannenstiel nephroureterectomy