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Inicio Actas Urológicas Españolas (English Edition) Comparative study of intact specimen extraction in laparoscopic nephrectomy by P...
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Vol. 47. Issue 4.
Pages 229-235 (May 2023)
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Vol. 47. Issue 4.
Pages 229-235 (May 2023)
Original article
Comparative study of intact specimen extraction in laparoscopic nephrectomy by Pfannenstiel incision
Estudio comparativo de la extracción de la pieza de nefrectomía laparoscópica mediante una incisión de tipo Pfannenstiel
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P.J. Suárez Sala,
Corresponding author
p.suarezsal@gmail.com

Corresponding author.
, S. Fernández-Pello Montesa, L. Rúger Jiméneza, P. Sánchez Verdesa, L. Rodríguez Villamila, I. Fernández Vegab,c
a Servicio de Urología, Hospital Universitario de Cabueñes, Gijón, Spain
b Servicio de Anatomía Patológica, Hospital Universitario Central de Asturias, Oviedo, Spain
c Departamento de Cirugía y Especialidades Médico-Quirúrgicas, Universidad de Oviedo, Oviedo, Spain
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Tables (3)
Table 1. Demographic characteristics and results of the sample.
Table 2. Surgical wound complications.
Table 3. Predictors of complications derived from the type of incision: logistic regression models.
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Abstract
Objectives

The aim of our study is to demonstrate that the Pfannenstiel incision is a reliable option in terms of postoperative complications compared to other types of incisions usually performed for kidney extraction after laparoscopic nephrectomy.

Materials and methods

Retrospective and comparative study of 256 patients who underwent laparoscopic nephrectomy or nephroureterectomy. Patients were divided into two groups: specimen extraction by Pfannenstiel incision (group 1) and specimen extraction by way of other incisions (group 2). Incisional hernia, surgical site infection, pain score, seroma, haematoma/bleeding, wound dehiscence and muscle paralysis were analyzed in each patient.

Results

Patients in Pfannenstiel group presented a rate of wound complications of 11.72% vs. 27.34% with other incisions, p=0.002, it was significantly inferior the rate of wound dehiscence (5.5% vs. 12.5%, p=0.047) and seroma (3.1% vs. 7.8%, p=0.022). Using multivariate logistic regression, Pfannenstiel incision was a significant protective predictor factor for wound complications (OR=0.34, p=0.005).

Conclusions

The Pfannenstiel incision allowed the extraction of bigger kidney masses with less incidence of dehiscence, seroma and in general wound complications. The hospital stay was lower in Pfannenstiel extraction group. These results present this incision as a reliable and safe option in the decision of which incision to select.

Keywords:
Pfannenstiel incision
Nephrectomy
Kidney cancer
Minimally invasive
Resumen
Objetivos

Nuestro objetivo es demostrar que la incisión de Pfannenstiel presenta un perfil más seguro en cuanto a complicaciones postoperatorias frente a otro tipo de incisiones que habitualmente se utilizan para la extracción renal laparoscópica.

Material y métodos

Estudio retrospectivo y comparativo de 256 pacientes intervenidos de nefrectomía o nefroureterectomía. Dividimos a los pacientes en dos grupos: extracción renal mediante incisión de Pfannenstiel (grupo 1) y extracción renal mediante otro tipo de incisiones (grupo 2). Evaluamos: aparición de eventración y evisceración clínica y subclínica, presencia de infección bacteriana significativa, presencia de dolor, aparición de seroma, hematoma/sangrado, dehiscencia de la herida y parálisis muscular en cada paciente.

Resultados

Los pacientes del grupo Pfannenstiel presentaron una tasa de complicaciones derivadas de la herida del 11.72% frente al 27.34% en el grupo no-Pfannenstiel, p=0.002, siendo significativo la menor tasa de dehiscencia (5.5% vs. 12.5%, p=0.047) y seroma (3.1% vs. 7.8%, p=0.022). El modelo de regresión logística multivariante mostró que la incisión de Pfannenstiel es un predictor de prevención de complicaciones derivadas de la herida quirúrgica (OR=0.34, p=0.005).

Conclusiones

La elección de una incisión de Pfannenstiel supuso una menor incidencia de dehiscencia y seroma de la herida quirúrgica, permitiendo la extracción de piezas de nefrectomía más voluminosas y con una menor estancia hospitalaria, lo que la convierte en una alternativa válida y segura, con un favorable perfil de complicaciones con respecto a otro tipo de incisiones.

Palabras clave:
Pfannenstiel incision
Nephrectomy
Kidney cancer
Minimally invasive

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