NEPHRECTOMY THROUGH A PFANNENSTIEL INCISION
ANIBAL W. BRANCO, ALCIDES J. BRANCO FILHO, WILLIAM KONDO, LUCIANO C. STUNITZ, BRENO DAUSTER, JARBAS VALENTE
Laparoscopic urologic surgery is generally performed using three to six
ports by transperitoneal or retroperitoneal access. Recent developments
regarding laparoscopic surgery have been directed toward reducing the
size or number of ports to achieve the goal of minimal invasive surgery,
by mini-laparoscopy, natural orifices access and transumbilical approach.
This video reports three cases of laparoscopic nephrectomies performed
thorugh a Pfannenstiel incision using conventional laparoscopic trocars
J Urol. 2010; 36 (Video #4): 247_8
In this surgical video by Branco et al., the authors demonstrate how placement of laparoscopic surgical trocars along incision sites which can be connected thereafter to a Pfannenstiel incision for specimen extirpation is a feasible alternative to conventional laparoscopic trocar placements at time of nephrectomy. This video provides a nice illustration of how this port placement strategy can be used by most practicing urologists. The video provides a nice overview of 3 separate surgical cases (i.e. simple, radical, and donor nephrectomy) in which this approach was utilized. The specialty of urology is in evolution as it has been one of the first to embrace the significant improvements in surgical instrumentation, ergonomics, and optics. With the integration of robotics and now single port access surgery to our surgical armamentarium, we are now faced with an equally challenging clinical question which is how far can we push the envelope without compromising safety or patient outcome? Another pertinent question is how can urologists keep abreast and competent with these evolving surgical technologies? I don’t think there is a simple answer to that question other than stating that clinicians must perform procedures that they are comfortable with and that fall within our surgical specialties realm of the standard of care at this point in time. Evolving technologies have and will continue to shape our surgical specialty for years to come however they must be compared in a rigorous evidence based approach to the surgical techniques which have up until now weathered the test of time.
Philippe E. Spiess