Incisional hernias following robotic-assisted laparoscopic prostatectomy: does the extraction site matter?

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Incisional hernia (IH) is a known complication following robotic-assisted laparoscopic prostatectomy (RALP), with reported incidence rates varying significantly.
• Small hernias may be asymptomatic, but larger ones pose risks of bowel strangulation and necessitate emergency surgery.

Purpose of the Study:

• To investigate the impact of specimen extraction site on the incidence of incisional hernias after RALP.
• To compare IH rates between supra-umbilical port extraction and Pfannenstiel incision extraction.

Main Methods:

• Retrospective chart review of a single surgeon's RALP series.
• Analysis of 69 patient charts with sufficient data, comparing outcomes before and after July 2017.
• Pre-July 2017: specimen extraction via supra-umbilical port. Post-July 2017: specimen extraction via Pfannenstiel incision.

Main Results:

• The IH rate was nearly double in the pre-July 2017 group (12.5%) compared to the post-July 2017 group (6.7%).
• No incisional hernias were observed at the Pfannenstiel extraction site in the post-July 2017 cohort.
• Three IH cases occurred at the supra-umbilical port in the pre-2017 group, and three at the supra-umbilical port (not extraction site) in the post-2017 group.

Conclusions:

• The site of specimen extraction significantly influences the incidence of incisional hernias following RALP.
• Utilizing a Pfannenstiel incision for specimen extraction appears to lower the risk of IH compared to supra-umbilical port extraction.
• Consideration should be given to optimizing specimen extraction techniques to minimize IH morbidity in RALP procedures.