Modified Pfannenstiel incision for intact specimen extraction after retroperitoneoscopic renal surgery

To describe a simple modification of the Pfannenstiel incision for performing intact specimen extraction during retroperitoneal laparoscopic radical nephrectomy.

After retroperitoneal laparoscopic radical nephrectomy is completed, and the specimen is entrapped in a specimen retrieval bag, a 5 to 7-cm Pfannenstiel (transverse) skin incision is made over the symphysis pubis, lateralized slightly toward the side of surgery. A vertical incision is then made in the anterior rectus fascia near the lateral aspect of the ipsilateral rectus muscle, from the level of the pubic bone extending cephalad for approximately 5 to 7 cm. The transversalis fascia is then perforated near the level of the pubis to enter the pelvic extraperitoneal space, which is developed to the upper retroperitoneum. The drawstring of the closed bag is grasped, allowing delivery of the entrapped intact specimen through the modified Pfannenstiel incision.

More than 50 specimen extractions have been performed in this manner, with specimen weights ranging up to 1.7 kg, after retroperitoneoscopic radical nephrectomy. No complications specific to this incision and no postoperative hernias have developed, although follow-up was short. Our modification combines the advantage of a potentially less painful, non-muscle-cutting Pfannenstiel skin incision with the advantages of retroperitoneal access afforded by a Gibson fascial incision. Although it has been our initial subjective impression that the degree of comfort and cosmesis from this modified Pfannenstiel incision may be better than that after enlargement of the primary port site, a detailed comparison of these two approaches is required.