Pfannenstiel Incision Research Articles

Association of Skin Incision Type With Postoperative Cesarean Delivery Complications in Morbidly Obese Patients.

To assess whether Pfannenstiel skin incision compared with vertical skin incision was associated with postcesarean delivery wound complications in morbidly obese women. We assembled a retrospective cohort of patients with body mass index (BMI) of 40 or higher who delivered by cesarean between July 2012 and May 2019. The primary outcome was a composite wound morbidity (until 42 days postpartum) including wound separation, infection, and dehiscence. Secondary outcomes included individual composite components plus select maternal and neonatal outcomes. Comparisons of demographics and outcomes were made by χ2 and t test. Logistic regression was performed. Subgroup analysis was performed according to location of vertical skin incision in relation to the umbilicus. A total of 3,901 patients were included. To account for imbalances in demographics between exposure groups, vertical and Pfannenstiel skin incision patients were matched in a 1:4 fashion for age, BMI, smoking status, and diabetes. The frequency of wound morbidity was 13.2% overall. There was no difference in the primary outcome when comparing Pfannenstiel with vertical skin incision (adjusted odds ratio [aOR] 1.5, 95% CI 0.8-2.8). Patients with a vertical skin incision were more likely to undergo vertical hysterotomy (aOR 138.7, 95% CI 46.9-410) and transfusion (aOR 5.4, 95% CI 1.8-16.5). When vertical skin incision was classified into supraumbilical and infraumbilical, and compared with Pfannenstiel skin incision, infraumbilical vertical skin incision was associated with increased wound morbidity (odds ratio [OR] 2.46, 95% CI 1.4-4.5) and wound infection (OR 2.5, 95% CI 1.4-4.6) compared with Pfannenstiel. Both types of vertical skin incision were associated with increased odds of vertical hysterotomy and transfusion when compared with Pfannenstiel. In morbidly obese women who underwent cesarean delivery, the frequency of postoperative wound morbidity was similar after Pfannenstiel and vertical skin incisions.

Clinical Issues—December 2021

Mold in the OR Key words: Aspergillus, mold, fungal infection, invasive pulmonary aspergillosis, neutropenia. Removing mold in the OR Key words: remediation, source, removal, containment, mold. Cesarean delivery surgical site prep Key words: cesarean delivery, umbilicus, surgical skin antisepsis, transverse Pfannenstiel incision, vertical incision. Commercially available premoistened single-use mop pad use in an ambulatory surgery center Key words: Environmental Protection Agency (EPA)-registered disinfectant, hospital-grade disinfectant, environmental cleaning, mopping, between-procedure turnover.

Incisional hernia appendicitis: A unique case report.

Introduction and importanceIncisional hernia appendicitis is very rare. Very few papers have been published reporting about Pfannenstiel incision hernia with appendicitis. Here we report one such case of Pfannenstiel hernia with appendicitis.Case presentationA 20 years old lady presented with a tender mass in the right iliac fossa after Pfannenstiel incision. Ultra-sonography showed an incisional hernia with a 12.1 mm defect at the site of the incision. A provisional diagnosis of strangulated hernia was made. Acute appendicitis was diagnosed intra-operatively. Appendectomy followed by primary repair of the hernia was done. The patient had an uneventful recovery postoperatively and was discharged on the third day without any complications. Histopathology confirmed appendicitis.Clinical discussionAmyand originally documented the presence of appendix within external hernias. The presence of appendicitis within an incisional hernia is even rarer. Hypermobility of the cecum, inflammatory adhesions from surgery and defects created during surgery have been considered as the pathological basis of such incisional hernias. A classic presentation of appendicitis may be absent in cases of incisional hernia appendicitis. Deviation from usual clinical symptoms often deviates from treating surgeons to assume it as strangulated/incarcerated hernia. Incisional hernia appendicitis management consists of appendectomy followed by subsequent primary hernia repair. The use of mesh for repair is not preferred.ConclusionIncisional hernia appendicitis diagnosis is almost always intraoperative. As the incidence of incisional hernia appendicitis is low, awareness about the possibility of its occurrence is essential to formulate a well-planned intra-operative strategy.

EP.FRI.265 Laparoscopic Right Hemicolectomy with Complete Mesocolic Excision for a T4 Caecal Tumour with Associated Phlegmon

Abstract A 67-years-old female presented with right lower abdominal pain and raised inflammatory markers. A computed tomography scan showed marked inflammatory changes with collections adjacent to terminal ileum. Patient was managed with intravenous antibiotics initially. Subsequent colonoscopy showed a bulky 8cm caecal pole tumour involving ileocaecal valve. Histopathology confirmed a diagnosis of moderately differentiated adenocarcinoma. Staging CT was negative for distant metastases. The patient subsequently proceeded to laparoscopic right hemicolectomy with complete mesocolic excision (CME). Intraoperatively the ileocolic vein was clipped just at the level of its confluence with superior mesenteric vein. The ileocolic artery was divided at its origin form superior mesenteric artery followed by division of right colic artery. The caecal mass was dissected off the abdominal wall. Proximally small bowel was resected 25cm form the ileocaecal valve and distally colon was divided up till mid transverse point. The specimen was extracted through a 9 cm Pfannenstiel incision. An intracorporeal isoperistaltic ileocolic side to side anastomosis was performed using a novel technique.1 The patient made full recovery and proceeded to adjuvant chemotherapy. Histology showed moderately differentiated T4 adenocarcinoma with tumour free lymph nodes. This case demonstrates intraoperative steps of laparoscopic complete mesocolic excision. CME is now becoming a standard due to improved oncological outcomes as it yields higher number of resected lymph nodes and better tumour clearance margins. This approach can be challenging due to variability in vascular anatomy, however, in experienced hands it is feasible and safe resulting in extensive lymphadenectomy and better oncological radicality. 1.https://www.ncbi.nlm.nih.gov/pubmed/28833963/

Single-port Mini-Pfannenstiel Robotic Pyeloplasty: Establishing a Non-narcotic Pathway Along With a Same-day Discharge Protocol

ObjectiveTo analyze the feasibility of a same day discharge protocol following single-port (SP) robotic pyeloplasty. Materials and MethodsFrom a single institution series, 23 patients (12 multi-port, 11 SP) who underwent primary robotic dismembered pyeloplasty between February 2018 and March 2021 were analyzed. The association between baseline and perioperative characteristics with functional outcome was analyzed using, chi-square, Fisher's exact, Mann Whitney U and t tests. ResultsAll SP cases were completed using the mini Pfannenstiel incision without the need for conversion or additional ports. Baseline characteristics were comparable. No intraoperative complications were seen. Only 1 patient in the SP group had a Clavien II complication. All patients in the multi-port group had a drain placed, whereas drain was not placed in the SP group. Length of stay was shorter in the SP group (11.4 vs 42.6 hours, P <.001). Although visual analog pain score was comparable at discharge (P = .633), the SP group had lower opioid usage (morphine milligram equivalent) in the hospital (P <.001) and a lower rate of opioid prescription during discharge (18.2% vs 91.7% P <.001). At a median follow-up of 8 months, no patients had flank pain and all patients had good kidney drainage on follow-up images. ConclusionSingle-port robotic dismembered pyeloplasty through a mini-Pfannenstiel access allows a same-day discharge protocol with minimal opiate use.

Expanding Horizons: Laparoscopic Management of Unruptured Cornual Heterotopic Pregnancy Safeguarding Intrauterine Pregnancy

<h3>Study Objective</h3> Feasibility of Minimally invasive surgery to handle extremely rare conditions of heterotopic cornual ectopic pregnancy. <h3>Design</h3> Compilation of videos consisting of four surgical procedures over six years performed on a patient with specific focus on heterotopic cornual ectopic pregnancy managed laparoscopically. <h3>Setting</h3> Operative laparoscopy for cornual ectopic pregnancy was performed under general anaesthesia in semi lithotomy position. Optical 11 mm trocar was introduced from umbilicus and other three ancillary 6 mm ports were used. C section of same patient at full term was carried out under regional anaesthesia with Pfannenstiel incision. <h3>Patients or Participants</h3> The patient had undergone laparoscopic bilateral neosalpingostomy as a part of fertility restoration surgery which was followed by bilateral salpingectomy for recurrent hydrosalpinx and tubal ectopic pregnancy. Following which patient underwent Assisted reproductive technique but unfortunately developed rare form of multiple gestation (heterotopic pregnancy with one left cornual ectopic component and second healthy intrauterine pregnancy). It was diagnosed in time and treated with operative laparoscopy. The intrauterine pregnancy continued till term and a healthy singleton child was delivered by C section at 37th week. <h3>Interventions</h3> I was prudent to avoid prolonged use of general anaesthesia and to reduce use of electrocautery on gravid uterus. For achieving effective hemostasis four stay sutures with delayed absorbable suture material was taken on both sides and base of ectopic gestation which was very vascular lesion due to gravid uterus. <h3>Measurements and Main Results</h3> With minimal use of electrocautery and without using vasoconstrictors or uterine artery ligation, extremely vascular cornual ectopic pregnancy was safely removed by operative laparoscopy. Myometrial defect was properly reconstructed with delayed absorbable sutures, without causing any short term or long-term harm to ongoing precious intrauterine pregnancy. <h3>Conclusion</h3> Extremely rare and complex situation of heterotopic cornual ectopic pregnancy can be very safely managed with proper application of principles of minimal invasive surgery safeguarding the intrauterine pregnancy.

Robotic-Assisted Uterus Retrieval from Living Donor for Uterine Transplantation: First Case in Brazil

<h3>Study Objective</h3> To present the first robotic-assisted uterus retrieval from a living donor for uterine transplantation in Brazil. <h3>Design</h3> Stepwise demonstration of the technique with narrated video footage. <h3>Setting</h3> Three operating rooms were designated to carry out the transplantation: one for harvesting the donor's uterus by robotic surgery, another for the bench surgery, and another for the organ recipient. The donor was in the lithotomy position with steep Trendelenburg, intermittent pneumatic compression, and Allen Stirrups. She underwent robotic surgery with central docking. <h3>Patients or Participants</h3> The recipient was a 33-year-old patient with hypoplasia of the Müllerian duct system due to Mayer-Rokitansky-Küster-Hauser syndrome. The donor was a 50-year-old woman. <h3>Interventions</h3> Ureteral dissection was performed over its entire length. The vascular pedicles that emerged from the uterine arteries and the internal iliac arteries' posterior branches were clipped. The obliterated umbilical arteries, the internal iliac arteries, and the pelvic infundibulum ligaments were clipped and cut. The uterus was retrieved through a Pfannenstiel incision to avoid complications to the uterine vessels. The organ was transplanted in the recipient by end-to-end anastomosis of the internal iliac arteries and end-to-side anastomosis of the external iliac vein with a gonadal vein from the infundibulopelvic ligament. <h3>Measurements and Main Results</h3> Surgical intraoperative parameters were measured. The operative time from docking was 4 minutes. Robotic donor surgery took 400 minutes, bench surgery 62 minutes, and laparotomic recipient surgery was completed in 240 minutes. There were no intraoperative complications. The donor was discharged in 48 hours and the recipient in 5 days. <h3>Conclusion</h3> This is the first case in Brazil of uterine transplantation with a living donor to the best of our knowledge. Traditionally, patients who undergo uterine transplantation by minimally invasive surgery are managed by laparoscopy. However, this video demonstrates the feasibility of a robotic approach to uterine transplantation.

890 Bilateral Acetabular Fractures Induced by An Epilepticseizure In a Paediatric Patient: A Unique Case Andits Management

Abstract Bilateral acetabular fractures following epileptic seizures are a rare but known occurrence in adults, with an 18.5% mortality rate. These fractures occurring post epileptic seizures have not been previously documented in children. We report a case of a 13-year-old boy who presented to hospital via ambulance following two violent generalised tonic–clonic seizures in a postictal state, metabolically acidotic and a low haemoglobin. Acute abdomen was suspected, and the patient underwent a CT scan which showed bilateral acetabular fractures with central dislocations of both femoral heads and free fluid in the abdomen. The patient underwent initial damage control intervention with insertion of bilateral distal femur skeletal traction. Definitive fixation of the acetabular fractures occurred 1 week later with an open reduction internal fixation with novel supra- pectineal plates using a Pfannenstiel incision. We use this report to increase awareness of significant pelvic injuries in paediatric patients post epileptic seizures.

The management of tubo-ovarian abscesses associated with appendicitis

A relatively uncommon medical complication, the tubo-ovarian abscess (TOA) can result from ascending pelvic infection in the female genital tract. The paper aims at exploring the characteristics of patients with TOA and at comparing the outcomes of the surgical management with postoperative recovery. A retrospective analysis of 25 cases diagnosed with bilateral, right or left TOA at “St. Apostol Andrei” Emergency Clinical County Hospital Constanta, Romania between January 2019 and December 2020 was performed. The patients’ clinical characteristics, age, environment of origin, socio-economic background, educational level, the means of contraception used, surgical procedures, and postoperative recovery were analyzed. Out of the 25 cases, 40% presented bilateral TOA, 32% right TOA and 28% left TOA and left adnexectomy. In 3 patients (37.5%) with right TOA, appendicectomy was also performed. In 72% of the cases, a median pubicumbilical incision was performed. The remaining 7 patients (28%) with left TOA underwent Pfannenstiel incision. All cases had a favorable postoperative evolution, the patients being discharged 5-9 days after surgery, benefiting from antibiotic therapy 10 days after their discharge. The coexistence of appendicitis and adnexal pathology should raise awareness for adopting a surgical strategy in order to prevent postoperative complications.

ESPLENECTOMÍA LAPAROSCÓPICA EN ESPLENOMAGALIA MASIVA POR LINFOMA NO HODGKIN DE ZONA MARGINAL.

Introduction: despite the fact that laparoscopic splenectomy for massive and supramassive splenomegaly constitutes a technical challenge, it is a feasible and safe procedure in the context of institutions with experienced teams in laparoscopic surgery.Objective: to present the first case of laparoscopic splenectomy for massive splenomegaly in Uruguay.Clinical case: the study presents the case of a 70-year-old patient carrier of peripheral pancytopenia, massive splenomegaly and a diagnosis of type B lymphoproliferative neoplasm based on bone marrow aspiration and biopsy, who underwent diagnostic and therapeutic splenectomy.The patient was operated in supine position with a 15-degree tilt, the trocars were placed under direct view, adapted to the size of the spleen which went from the diaphragm until the superior pelvic outlet. Splenectomy was performed in 220 minutes, the entire piece was removed through a hemi Pfannenstiel incision, without placing it in a bag, the wall being protected with a surgical wound retractor. There were no complications and the patient was discharged from hospital 48 hours. The blood count performed after 24 hours evidenced increase in all cell series and the pathology report confirmed diagnosis of marginal zone non- Hodgkin lymphoma.Discussion: laparoscoppic splenectomy in massive splenomegaly requires of a greater surgical time, although blood loss and hospital star are lower when compared to conventional procedures and evidence similar morbility. The initial experience of surgical teams reports 30% of conversions and readmissions.

Uterine Transplantation with Robot-assisted Uterus Retrieval from Living Donor: First Case in Brazil

To present the first robot-assisted uterus retrieval from a living donor for uterine transplantation in Brazil. Stepwise demonstration of the technique with narrated video footage. A uterine transplantation was performed in a 33-year-old patient with Mayer-Rokitansky-Küster-Hauser syndrome. The donor was a 50-year-old woman who underwent a robotic-assisted uterus retrieval. The procedure was held at Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil. After approval from the national and local institutional review board, the protocol was submitted to ClinicalTrials.gov (NCT04249791), and the first case was performed. The screening of the patients was done. The uterus was retrieved through a Pfannenstiel incision to avoid complications to the uterine vessels. Uterus was transplanted in the recipient by end-to-end anastomosis of the internal iliac arteries and end-to-side anastomosis of the external iliac vein with a gonadal vein from the infundibulopelvic ligament. Surgical intraoperative parameters were measured. The docking time was 4 minutes. Robotic donor surgery took 400 minutes, bench surgery took 62 minutes, and laparotomic recipient surgery was completed in 240 minutes. There were no intraoperative complications. The donor patient was discharged from the hospital in 48 hours and the recipient patient in 5 days. To the best of our knowledge, this is the first case in Brazil of uterine transplantation with a living donor. Traditionally, patients who undergo uterine transplantation by minimally invasive surgery are managed by laparoscopy. This video demonstrates a feasible robotic approach to uterine transplantation with superior imaging affording a 3-dimensional vision and stabilization of instruments allowing wrist-like movements.

Successful Outcome of Uterocutaneous Fistula: A Case Report

Uterocutaneous fistula is a rare complication that occurs after cesarean section and other pelvic operations. Here we report a case of a 27 years woman presented to our department with a mass and pus-like discharge coming from her previous Pfannenstiel incision for 1 month. The definitive treatment of such cases is hysterectomy but the case was managed by fistulectomy along with gonadotropin-releasing hormone agonist.

V08-06 BILATERAL PYELOPLASTY WITH SINGLE PORT ROBOT - ONE INCISION, ONE POSITION

You have accessJournal of UrologyNOTES/LESS (V08)1 Sep 2021V08-06 BILATERAL PYELOPLASTY WITH SINGLE PORT ROBOT - ONE INCISION, ONE POSITION John Sheng, Chrystal Chang, Gregory Lovallo, Michael Stifelman, and Mutahar Ahmed John ShengJohn Sheng More articles by this author , Chrystal ChangChrystal Chang More articles by this author , Gregory LovalloGregory Lovallo More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , and Mutahar AhmedMutahar Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002041.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Da Vinci Single Port (SP) robotic system has made it feasible to perform robotic surgery through one incision. This technology advances minimally invasive surgery, allowing for multiple instruments through a single 25mm port. -In this video, we demonstrate the feasibility of performing bilateral retroperitoneal surgery through a single small Pfannenstiel incision. -We previously showed this surgery with an assistant port. Now we demonstrate the use of the remotely operated suction irrigation (ROSI) system in making this a true single port surgery. METHODS: A 26 year old female with bilateral symptomatic UPJ obstructions and multiple large left kidney stones presented for robotic assisted bilateral pyeloplasty and left pyelolithotomy. Whereas using a multiport approach may have necessitated more than 5 incisions to perform bilateral surgery, we demonstrate using one incision and re-docking the single port robot to perform bilateral pyeloplasty. We did not need to re-drape the patient in order to perform the second side. RESULTS: Our patient tolerated the procedure well with excellent cosmetic and functional outcomes. Foley catheter was removed 12 hours post op. Drain had minimal output and was removed 2 hours after foley removed. Patient was discharged within 18 hours of surgery without any narcotic use post operatively. Stents were removed 4 weeks later and the patient remains asymptomatic. A total of 24 single port pyeloplasties were performed by three surgeons at our institution over an 18 month period. Two, including the one described in this video, were bilateral. Average operative time was 128 minutes. Average estimated blood loss was 20cc. Average length of stay was 1.1 days. CONCLUSIONS: Using Single Port robot has the potential to: Have better cosmesis with only one incision. Have improved pain control. Be able to use lower incision on abdomen to perform kidney surgery by pointing instruments upward. Advance robotic surgery in an even more minimally invasive way. In this video, we are able to demonstrate bilateral retroperitoneal surgery without the use of an assistant port through a single small Pfannenstiel incision. Limitations: SP has a learning curve and is may not be able to translate multiport skills entirely to single port. Cannot use indocyanine green with single port system yet to be able to identify and preserve vascularity of ureter for reconstructive cases. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e602-e602 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Sheng More articles by this author Chrystal Chang More articles by this author Gregory Lovallo More articles by this author Michael Stifelman More articles by this author Mutahar Ahmed More articles by this author Expand All Advertisement Loading ...

Women’s Preference for Cosmesis of Incisions Used for Open Versus Robotic Lower Urinary Tract Reconstructive Surgery

OBJECTIVE: To compare the cosmetic appeal of incisions used for open (Pfannenstiel or Vertical midline) versus robotic-assisted laparoscopic lower urinary tract reconstructive surgery in women.&#x0D; STUDY DESIGN: Cross-sectional descriptive study&#x0D; PLACE AND DURATION: Outpatient Urology Clinic of Western General Hospital, Edinburgh Scotland, UK from 1st February 2019 till 28th February 2020. &#x0D; METHODS: All patients were provided illustrations of Pfannenstiel incision (incision at “bikini line”- (A), Vertical midline laparotomy incision (incision from midline symphysis to umbilicus –( B), Robotic-assisted laparoscopic incisions-variation I- (C) and Robotic-assisted laparoscopic incisions-variation II (-D). Patients were asked to rate each incision in order of their preference. Chi square distribution was used to compare mean previous surgeries and no previous surgeries between different preferred incisional groups and ages of the patients.&#x0D; RESULTS: One hundred patients with mean age were 53.11±15.05 years with minimum 19 years and maximum 84 years and mean BMI was 28.18±7.05 kg/m2 with minimum 15.6 and maximum 55 kg/m2 calculated. Out of 100 patients (1st preference of incision), 78% preferred incision A, 3% preferred B incision and 16% &amp; 3% patients preferred incision C and D respectively. Similarly (2nd preference of incision) 3% patients preferred incision A, 19% preferred B incision and 56% &amp; 22% patients preferred incision C and D respectively. The mean comparison between first preferred incision with second preferred incision with respect of surgeries (previous surgeries and no previous surgeries) showed significant difference p≤0.05 (chi value=167.692, p=0.000). Relation of preferred incisions with respect to ages of the patients showed no significant difference (Pearson relation value -0.182 and p=0.069).&#x0D; CONCLUSION: Overall, open incisions were preferred over robotic incisions. Patient perception of the "visibility" of abdominal incisions and previous experience in term of surgical scars may be the distinguishing issue to explain the difference in the preferences between open versus robotic-assisted laparoscopic incisions in women.

Feasibility and efficacy of surgical staging for endometrial cancer by using Pfannenstiel incision

Objective: The purpose of this study was to evaluate short-term oncological and perioperative outcomes of using Pfannenstiel incision for the surgical staging of endometrial carcinoma. Methods: This was a retrospective cohort study. All patients with endometrial carcinoma referred to the Department of Surgical Oncology, South Egypt Cancer Institute, for surgical staging between January 1, 2014, and July 1, 2016, were enrolled. The patients were grouped according to the type of surgical incision either through Pfannenstiel incision or midline incision, and the groups were compared. Demographic, clinical, operative, and short-term oncological features were analyzed. Results: A total number of 117 patients were recruited, of which 45 patients had Pfannenstiel incision, and 72 patients had midline incision. The clinical and pathological features of patients in both groups were similar. The operative outcomes showed no significant difference between the groups (p &gt; 0.1). Postoperatively, the Pfannenstiel incision group had a statistically significant lower rate of complications compared to the midline incision group (15.5% vs. 38.9%, p = 0.02). The short-term oncological outcomes in the form of total procured lymph nodes or para-aortic lymph nodes were not statistically different (p &gt; 0.1). Conclusion: Pfannenstiel incision can be safely performed for the surgical staging of endometrial cancer with acceptable oncological outcomes compared to the midline incision.

Single-Port Donor Nephrectomy via Modified Pfannenstiel Incision: Initial Preclinical Experience in a Cadaveric Model and Description of Technique.

Objective: To describe the surgical technique for the single-port (SP) transperitoneal donor nephrectomy (DN) through a modified Pfannenstiel incision using the Da Vinci SP® surgical system (Intuitive Surgical, Sunnyvale, CA) on a cadaver. Patients and Methods: In a male cadaver, the SP surgical system was used to perform transperitoneal DN. A 3-cm modified Pfannenstiel incision was made. Through the incision GelPOINT mini (Applied Medical, Rancho Santa Margarita, CA) was inserted. The floating docking technique was used. Through the gel port, the dedicated 25-mm multichannel port and a 12-mm assistant port were introduced. The surgical steps for DN were performed in the following order: (1) mobilization of the colon, (2) identification of psoas muscle, ureter, and the gonadal vein, (3) hilum dissection, (4) perirenal dissection, (5) stapling the renal artery and renal vein, and (6) removal of the kidney through the enlarged incision. Results: Transperitoneal SP DN was completed without any complications or capsulotomy. Additional ports were not needed. The total operative time was 63 minutes and 54 seconds. A good-quality kidney was harvested. Renal artery length was 4 cm. Conclusion: We demonstrated the feasibility of SP transperitoneal DN through modified Pfannenstiel incision, using the novel SP robotic platform. Further assessment is necessary in a clinical setting.

Robot-assisted Kidney Transplantation.

This paper describes robot-assisted kidney transplantation (RAKT) from a living donor. The robot is docked between the parted legs of the patient, placed in the supine Trendelenburg position. Kidney allografts are provided by a living donor. Before vascular anastomosis, the kidney allograft is prepared by inserting a double-J stent in the ureter, and the temperature for the anastomosis is lowered by wrapping it in an ice-packed gauze. A 12 mm or 8 mm port for the robotic camera and three 8 mm ports for robotic arms are placed. A peritoneal pouch is created for the kidney allograft by raising the peritoneal flaps on both sides over the psoas muscle before dissecting the iliac vessels and bladder. A 6 cm Pfannenstiel incision is made to insert the kidney into the peritoneal pouch, lateral to the right iliac vessels. After clamping the external iliac vein with Bulldogs clamps, a venotomy is performed, and the graft renal vein is anastomosed to the external iliac vein in an end-to-side continuous manner with a 6/0 polytetrafluoroethylene suture. After clamping the graft renal vein, the iliac vein is declamped. This is followed by clamping of the external iliac artery, arteriotomy, arterial anastomosis with a 6/0 polytetrafluoroethylene suture, clamping of the graft renal artery, and declamping of the external iliac artery. Reperfusion is then carried out, and ureteroneocystostomy is performed using the Lich-Gregoir technique. The peritoneum is closed at a few locations with polymer locking clips, and a closed-suction drain is placed through one of the working ports. After deflating the pneumoperitoneum, all incisions are closed.

Controlled aspiration of large paediatric ovarian cystic tumours

AimCystic ovarian masses in children may be physiological or neoplastic. It is mandatory that suspected neoplastic lesions are resected without tumour spillage. However, a large midline incision is cosmetically unappealing incision to young women. Here we describe our experience of using controlled drainage without spillage that allows a cosmetic pfannenstiel approach without compromising oncological principles. MethodAll girls treated with large ovarian cystic masses since 2008 in our centre were identified and data was collected prospectively.A small pfannenstiel incision was performed followed by peritoneal washings; tissue glue was used to stick an Opsite™ dressing to the cyst surface and fluid drained so there was no leakage back into the patient. Once aspirated the cyst was delivered and an ovarian preserving cystectomy was performed where possible. ResultsTwenty-three girls (median age 14.5 years (8.1 to 16.5 years) were included. Pre-operative MRI scan showed a complex lesions with median volume of 1169 ml (range 252–7077 ml). At surgery 22/23 cysts were intact and removed without spillage. Histology: mature teratoma (11), serous cyst (3), mucinous cyst adenocarcinoma (2), mucinous cystadenoma (5), Sertoli-Leydig tumour, sclerosing stromal tumour. One girl with pre-operative rupture of a mucinous adenocarcinoma subsequently died. Ovarian sparing cystectomy was performed in 17/23 girls. All other patients are well without evidence of recurrence. ConclusionThis is the largest series in children and adolescents using controlled drainage of cystic ovarian tumours. Though there were a range of diagnoses we have shown that these can be removed safely with a cosmetic pfannenstiel approach while following oncological principles.

APACHE—Anterior Plating of the Acetabulum in Hemi-Endoscopic Technique: An Alternative Method for Internal Fixation of the Acetabulum

Injuries of the acetabulum are often challenging in treatment and aftercare. One reason is the required surgical approach, which has high complication rates, including vascular lesion, hernias, and wound infection. We present an alternative endoscopic-assisted approach for the internal fixation of acetabular fractures to avoid the Pfannenstiel incision. An endoscopic approach similar to that used for endoscopic hernia surgery was used. The ilioinguinal approach’s lateral window was used to achieve reduction and insertion of a reconstruction plate. The purpose of this study is to describe a minimally invasive technique as a possible method to reduce hospitalization and complications. Another goal is to give detailed technical recommendations and to assess the potential pitfalls of this surgical approach. The APACHE technique is a safe and suitable minimally-invasive approach for the successful treatment of complex acetabular fractures and can be considered in similar cases.

INITIAL STUDY OF THE SELECTION OF THE TYPE OF INCISION FOR THE SPECIMEN EXTRACTION AFTER A LAPAROSCOPIC NEPHRECTOMY: PFANNENSTIEL INCISION

Abstract INTRODUCTION The transverse hypogastric Pfannenstiel incision is one of the possibilities for specimen extraction after a laparoscopic nephrectomy. Its advantages include low morbidity and a favorable cosmetic result. MATERIAL AND METHODS Retrospective and comparative observational study of 105 patients who underwent nephrectomy in our center. Group 1: renal extraction through Pfannenstiel incision. Group 2: renal extraction using other techniques. The presence of infection, incisional hernia and pain (visual analogue scale-VAS) was evaluated in each patient. Additionally, a telephone survey was conducted on the cosmetic results. RESULTS 105 patients: 68 group 1 (Pfannenstiel incision) and 37 group 2 (other incisions). The median size of the nephrectomy specimen was 14 cm (group 1 15cm, group 2 13cm). 27 patients (26%) had pain in the area of the hypogastric incision in the early postoperative period with a median on the VAS scale of 4 (16 group 1 vs 11 group 2). 3 patients (2.8%) presented incisional hernia (0 group 1 vs 3 group 2). 3 patients presented wound infection (0 group 1 vs 3 group 2). 70% of the patients in group 1 (48/68) answered the survey on cosmetic satisfaction: 93% were satisfied with the scar and its location. 49% of the patients in group 2 (18/37) answered the survey on cosmetic satisfaction: 83% were satisfied with the scar and its location. CONCLUSIONS The Pfannenstiel incision is a valid and safe alternative for laparoscopic nephrectomy specimen extraction with a favorable complication and cosmetic profile compared to other common techniques for nephrectomy specimen extraction.