Serkan DOĞAN, Bülent ÇELİK, Mehmet YILMAZ

Laparoskopik nefrektomide spesmen çıkarma yönteminin hasta memnuniyetine etkisi

Amaç: Bu çalışma laparoskopik nefrektomi sonrası spersmen çıkan bölgedeki ağrı, yaşam kalitesi ve hasta memnuniyeti değerlendirildi. Gereç ve Yöntemler: Kliniğimizde 2016-2017 yılları arasında laparoskopik nefrektomi yapılan 52 hasta çalışmaya dahil edildi. Hastaların demografik ve cerrahi özellikleri kaydedildi. Hastalar spesmen çıkarımında kullanılan insizyona göre üç grupta değerlendirildi: port yeri genişletilenler (n= 26), Gibson (n = 10) ve Pfannenstiel (n = 16) insizyonları. Gruplar görsel analog skala ile ölçülen postoperatif ağrı skorları, komplikasyonlar ve yaşam kalitesi skalasına göre ölçülen hasta memnuniyeti açısından karşılaştırıldı. Bulgular: EPS, Gibson ve Pfannenstiel gruplarında 3. saat VAS ortalaması sırasıyla 2.46 ± 2.06, 4.70 ± 2.90 ve 2.50 ± 2.47 idi. EPS, Gibson ve Pfannenstiel gruplarının ortalama 9. saat VAS ortalamaları sırasıyla 2.53 ± 2.06, 2.80 ± 2.97 ve 2.50 ± 2.12 idi. EPS, Gibson ve Pfannenstiel grupları için 72 saatlik VAS ortalamaları sırasıyla 0.53 ± 0.76, 1.60 ± 1.95 ve 1.18 ± 1.51 idi. 3, 9, 24 ve 72. saatlerde ortalama toplam VAS sırasıyla 2.90 ± 2.40, 2.57 ± 2.23, 1.94 ± 2.13 ve 0.94 ± 1.34 idi. Cerrahi örnek çıkarım yöntemleri arasında ağrı ve hasta memnuniyeti açısından anlamlı fark yoktu (p> 0.05). Kullanılan CO2 hacmi veya insizyon uzunluğu (145.5 ± 84.7, 124.3 ± 47.6, 135.7 ± 75.2L) (3.2 ± 1.72, 7.3 ± 2.49, 7.78 ± 1.26cm) gibi ameliyatla ilgili sonuçlara göre yöntemler arasında anlamlı bir fark yoktu. (p> 0.05). Hastanede yatış süresinde anlamlı fark yoktu (4.0 ± 2.26, 6.2 ± 4.34, 4.12 ± 1.62days) (p> 0.05). Pearson korelasyon testine göre, ameliyat sonrası ağrıyı etkileyen tek önemli faktör uzamış operasyon idi (p = 0.039). Sonuç: Farklı örnek çıkarım yöntemleri morbiditeyi değiştirmez. Spesmen çıkarım yönteminden bağımsız olarak hasta memnuniyeti yüksektir.

Anahtar Kelimeler:

Laparoskopi, nefrektomi, ağrı

The effect of specimen extraction site on patient satisfaction in laparoscopic nephrectomy

Introduction: This study aimed to evaluate the patient satisfaction and postoperative pain in location of specimen extraction as well as quality of life following surgery. Material and Methods:A total of 52 patients who underwent laparoscopic nephrectomy in our clinic between 2016 and 2017 were included in the study.Demographic and surgical characteristics were documented.Patients were evaluated in three groups according to incision used for specimen extraction:expanded port site(n=26),Gibson(n=10) and Pfannenstiel(n=16) incisions;patients were analyzed in terms of postoperative pain scores measured by visual analogue scale, complications and patient satisfaction measured by quality of life scale. Results: The mean of the 3rd hour VAS for EPS, Gibson and Pfannenstiel groups were 2.46±2.06, 4.70±2.90 and 2.50±2.47,respectively. The mean 9th hour VAS averages for EPS, Gibson and Pfannenstiel groups were 2.53±2.06, 2.80±2.97 and 2.50±2.12, respectively. For EPS, Gibson and Pfannenstiel groups, 72-hour VAS averages were 0.53±0.76, 1.60±1.95 and 1.18±1.51, respectively. The mean total VAS at the 3rd, 9th, 24th and 72th hours were 2.90±2.40, 2.57±2.23, 1.94±2.13 and 0.94±1.34,respectively. There was no significant difference in surgical specimen extraction in terms of pain and patient satisfaction(p>0.05). There was no significant difference between the methods according to surgery-related results such as used CO2 volume or incision length(145.5±84.7, 124.3±47.6, 135.7±75.2L) (3.2±1.72, 7.3±2.49, 7.78±1.26cm)(p>0.05). There was no significant difference in hospitalization time(4.0±2.26, 6.2±4.34, 4.12±1.62days)(p>0.05). According to the Pearson correlation test, prolonged operation was the only important factor affecting post-operative pain(p=0.039). Conclusion: Different specimen extraction methods do not alter morbidity. Patient satisfaction is high, independent from specimen extraction method.

Keywords:

Laparoscopy, nephrectomy, pain,

PDF

___

1- Stellato TA. History of laparoscopic surgery. Surg Clin North Am. 1992 Oct;72 (5):997-1002. Laparoscopic general surgery-past, present, and future. Surgery 1993; 113 (1):1-3.
2- McDougall EM, Clayman RV. Advances in laparoscopic urology, Part I. History and development of procedures. Urology 1994; 43 (4):420-426. Review.
3- Siani LM, Ferranti F, Benedetti M, De Carlo A, Quintaliani A, Laparoscopic versus open radical nephrectomy in T1-T2 renal carcinoma: personal 5-year experience about the oncologic outcome. Minerva Chir 2011; 66:317-321.
4- Hemal A.K., et al. Laparoscopic versus open radical nephrectomy for large renal tumors: a long-term prospective comparison. J Urol 2007; 177:862.
5- Abbou CC, Cicco A, Gasman D, Hoznek A, Antiphon P, Chopin DK, et al. Retroperitoneal laparoscopic versus open radical nephrectomy. J Urol 1999; 161:1776-1780.
6- McDougall EM, Clayman RV. Advances in laparoscopic urology, Part I. History and development of procedures. Urology 1994; 43 (4):420-6. Review.
7- Clayman R.V. Kavoussi L.R. Soper N.J. Dierks S.M. Meretyk S. Darcy M.D. Roemer F.D. Pingleton E.D. Thomson P.G. Long S.R. Laparoscopic nephrectomy: initial case report. J.Urol. 1991; 146 (2):278-282.
8- El- Galley R: Surgical management of renal tumours. Radiol Clin North Am 2003; 41:1053-1065.
9- Taylor GD, and Cadeddu JA: Applications of laparoscopic surgery in urology:impact on patient care. Med Clin North Am 2004; 88:519-538.
10- Walther MM, McClellan M, Lyne JC,et al:Laparoscopic cytoreductive nephrectomyas preparation for administration of systemic interleukin-2 in the treatment of metastatic renal cell carcinoma:a pilot study. Urology 1999; 53:496-501.
11- Wolf JS, Marcovich R, Merion RM, et al: Prospective, case matched comparison of hand assisted laparoscopic and open surgical live donor nephrectomy. J Urol 2000; 163:1650-1653.
12- Ratner LE, Montgomery RA, and Kavoussi LR: Laparoscopic live donor nephrectomy:a review of the first 5 years. Urol Clin North Am 2001; 28:709-719.
13- Ono Y, Kinukawa T, Hattori R, et al:Laparoscopic radical nephrectomy for renal cell carcinoma: a five-year experience. Urology 1999; 53:280-286.
14- Townsend CM: Sabiston Textbook of surgery, 17th ed. Philadelphia, WB Saunders, 2001, pp 445-464.
15- Gill, I.S.: Laparoscopic radical nephrectomy for cancer. Urol. Clin. North America 2000; 27 (4): 707-719.
16- Dunn MD, Portis AJ, Shalhav AL, Elnahnasy AM, Heidorn C, McDougall EM, Clayman RV: Laparoscopic versus open radical nephrectomy: A 9 year experience. J. Urol 2000; 1164: 1153-1159.
17- Britton Tisdale, Anil Kapoor, Abdullatif Hussain, Kevin Piercey and J Paul Whelan. Intact specimen extraction in laparoscopic nephrectomy procedures: Pfannenstiel versus expanded port site incisions. J Urology 2007; 69:240-244.
18- Gill IS, Kerbl K, Meraney AM, et al:Basics of laparoscopic urology surgery, in Walsh PC, Retik AB, Vaughan ED, et al (Eds):Campbell’s Urology, 8 th ed. Philadelphia,WB, Saunders, 2002, pp 3457-3458.
19- Depp R:Cesarean delivery, in Gabbe SG, Niebyl, JR, Simpson JL (Eds):Obstetrics: Normal and Problem Pregnancies, 4 th ed. New York, Churchill Livinngstone, 2002, pp 549-550.
20- Elashry OM, Giusti G, Nadler RB, et al: Incisional hernia after laparoscopic nephrectomy with intact specimen removal: caveat emptor. J Urol 1997; 158:363-369.
21- Whiteside JL, Barber MD, Walters MD, et al:Anatomy of ilioinguinal and iliohipogastric nerves in relation to trocar placement and low transverse incisions. Am J Obstet Gynecol 2007; 189:1574-1578.
22- Savage SJ, and Gill IS: İntact specimen extraction during renal laparoscopy: muscle-splitting versus muscle-cutting incision. J Endourology 2001; 61:165-169.
23- Camargo AH, Rubenstein JN, Ershoff BD, Meng MV, Kane CJ and Stoller ML: The effect of kidney morcellation on operative time, incision complications, and post operative analgesia after laparoscopic nephrectomy. İnt Braz J Urol 2006; 32:273.
24- Troxel SA, Das D. İncisional hernia following hand-assisted laparoscopic surgery for renal cell cancer. JSLS 2005; 9:196.
25- A Bbou, CC,Cicco, A,Gamsan: Retroperitoneal laparoscopic versus open redical nephrectomy. J Urol 1999; 161:1776-1780.