Application of hidden incision for specimen extraction during robot-assisted laparoscopic pediatric radical nephrectomy

Objective To explore the value of hidden incision for specimen extraction during pediatric robot-assisted laparoscopic radical nephrectomy. Methods The clinical data of robotic-assisted laparoscopic radical nephrectomy were retrospectively analyzed. Six patients undergoing robot-assisted laparoscopic radical nephrectomy were recruited from August 2015 to February 2019. There were 4 boys and 2 girls with a mean age of 47 months. There were Wilms' tumor (n=3), Xp11.2 translocation renal cell carcinoma (n=2) and metanephric adenoma (n=1). The involved side was left (n=3) and right (n=3). With a 60° lateral position, eyepiece Trocar was located at umbilical contralateral margin. The operation hole 1 was located at 6-7 cm above anterior median line (depending upon abdominal wall space) and operation hole 2 at the intersection of anterior median line and lower transverse Pfannenstiel incision. Trocar was sneaked under skin and then inserted into abdominal cavity (1.5 cm above operation hole 2) if auxiliary hole was needed. Auxiliary hole Trocar was placed on the affected side of lower abdominal transverse line. All children underwent radical resection. After removal, specimen was placed into a specimen bag. Then lower abdominal transverse incision (length of incision equal to the minimal renal diameter) was extended. The specimen bag was extracted through the Pfannenstiel incision. Results Auxiliary hole was applied in 3 cases with an average length of incision at 6.5(5-8) cm. All specimens were intactly extracted. The average postoperative hospital stay was 4.5(4-7) days. No active bleeding, splitting or infection of wounds occurred postoperatively. During an average follow-up period of 25(4-46) months, postoperative wound recovery was excellent and there was no scar hyperplasia. Conclusions The hidden Pfannenstiel incision may be safely and effectively applied for specimen extraction during pediatric robot-assisted laparoscopic radical nephrectomy. Key words: Kidney neoplasms; Hidden incision; Robot assisted laparoscopic surgery; Child