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Laparoscopic nephrectomy - Pfannenstiel or expanded port site specimen extraction: a systematic review and meta-analysis.

Amer T, Biju RD, Hutton R, Alsawi M, Aboumarzouk O, Hasan R, Clark R, Little B - Cent European J Urol (2015)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Ayr Urology Department, Ayr, United Kingdom.

ABSTRACT

Introduction: To anaylse the current evidence regarding the safety, feasibility and advantages of intact specimen extraction via various extraction sites after conventional laparoscopic nephrectomy (LN).

Material and 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.

No MeSH data available.


Related in: MedlinePlus

Forest plot comparing wound complications.
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Figure 0007: Forest plot comparing wound complications.

Mentions: In both analyses by Tisdale [2], the PFN group had a significant reduction in narcotic use when compared with the EPS group; p <0.006 and p <0.002 respectively. The difference is not significant on meta-analysis (two studies, 279 participants): MD 14.29, 95% CI from -5.77 to 34.35, p = 0.16, I2 = 85%). The Adiyat [8] study is limited by very small sample sizes, however, and this may well explain the significant heterogeneity encountered. (Figure 7).


Laparoscopic nephrectomy - Pfannenstiel or expanded port site specimen extraction: a systematic review and meta-analysis.

Amer T, Biju RD, Hutton R, Alsawi M, Aboumarzouk O, Hasan R, Clark R, Little B - Cent European J Urol (2015)

Forest plot comparing wound complications.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4643698&req=5

Figure 0007: Forest plot comparing wound complications.
Mentions: In both analyses by Tisdale [2], the PFN group had a significant reduction in narcotic use when compared with the EPS group; p <0.006 and p <0.002 respectively. The difference is not significant on meta-analysis (two studies, 279 participants): MD 14.29, 95% CI from -5.77 to 34.35, p = 0.16, I2 = 85%). The Adiyat [8] study is limited by very small sample sizes, however, and this may well explain the significant heterogeneity encountered. (Figure 7).

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Ayr Urology Department, Ayr, United Kingdom.

ABSTRACT

Introduction: To anaylse the current evidence regarding the safety, feasibility and advantages of intact specimen extraction via various extraction sites after conventional laparoscopic nephrectomy (LN).

Material and 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.

No MeSH data available.


Related in: MedlinePlus