BERKELEY, CA (UroToday.com) - The introduction of potentially effective adjuvant therapy, such as Sunitinib, for renal cell carcinoma challenges the clinical practice of morcellation of laparoscopic radical nephrectomy (LRN) specimens. As such, this retrospective review of intact specimen extraction techniques in laparoscopic nephrectomy is particularly germane. Although the paper includes laparoscopic radical nephrectomy, laparoscopic nephroureterectomy, and laparoscopic donor nephrectomy, the authors have very wisely reported the LRN group separately. They compared a Pfannenstiel (PFN) (N=31 patients) and an expanded port site (EPS) (N=73 patients) incision for the intact morcellation. The EPS was a lateral port site not a midline incision site. In the LRN group only analysis, the PFN group had less blood loss (130 versus 405 ml, p=0.05), a shorter hospital stay (2.8 versus 3.4 days, p less than 0.05), and significantly less morphine requirement postoperatively (24 versus 47 mg, p less than 0.006) compared to the EPS group. There was no significant difference in the complication rates between the two groups. However, incisional wound hernias (3) occurred only in the EPS group. Although, it is important to note that the EPS group had a higher BMI than the PFN group, and in our experience this does increase the risk of wound hernia when the EPS extraction is utilized. The laparoscopic urologist should consider PFN intact removal for the LRN specimen, especially in obese patients.

Tisdale BE, Kapoor A, Hussain A, Piercey K, Whelan JP.

Urology 2007; 69(2):241-244

UroToday.com Renal Cancer Section

Written by Elspeth M. McDougall, MD, a Contributing Editor with UroToday.

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