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Incisional hernias following robotic-assisted laparoscopic prostatectomy: does the extraction site matter?
Marianna Zukiwskyj1, Alice Nicol2, Peter Heathcote3
1Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD, 4102, Australia. marianna.zukiwskyj@uqconnect.edu.au.
Abstract:
The incidence of incisional hernia (IH) following robotic-assisted laparoscopic prostatectomy (RALP) varies widely within the literature (0.4-9.7%). Whilst small hernias may go unnoticed, the potential exists for bowel strangulation and subsequent emergency surgery. We suggest that the extraction site may influence the rate of IH. A retrospective chart review of a single surgeon RALP series was undertaken. One hundred charts were sampled, of which 69 had sufficient data to be analysed. Prior to July 2017, specimen extraction had been via the supra-umbilical port site. After this time, specimens were extracted via a Pfannenstiel incision. Of the 69 patients, 24 underwent RALP prior to July 2017. Three patients developed IH at the supra-umbilical port extended for extraction site in the pre-2017 group and three patients developed IH at the supra-umbilical port (not extraction) site in the post-2017 group. The rate of IH was almost double in the pre-July 2017 group (12.5% vs. 6.7%). No patient developed an incisional hernia at the Pfannenstiel site in the post-2017 group. In our series, no patient developed a hernia at the Pfannenstiel site. This is in keeping with the reported < 1% IH rate following Pfannenstiel specimen extraction. Given that incisional hernias are a known complication of robotic surgery, thought should be given to changing the site of specimen extraction site to lower the rate of incisional hernias and the morbidity associated with such.
Insights
Changing the specimen extraction site after robotic-assisted laparoscopic prostatectomy (RALP) may reduce incisional hernias (IH). Extracting specimens via a Pfannenstiel incision, rather than the supra-umbilical port, nearly halved the IH rate in this study.
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.
