Randomized Trial of Transverse vs Vertical Extraction Site Incision After Robotic Radical Prostatectomy

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Incisional hernias are a common complication after robotic radical prostatectomy.
• Previous observational studies suggested transverse closure may reduce hernia rates compared to vertical closure.

Purpose of the Study:

• To compare the incidence of incisional hernias following robotic radical prostatectomy based on vertical versus transverse extraction site closure.

Main Methods:

• A crossover, cluster randomized trial involving 1356 patients undergoing minimally invasive radical prostatectomy.
• The primary outcome was the incidence of incisional hernia within 15 months, defined by physical examination and patient surveys.

Main Results:

• No significant difference in incisional hernia rates was observed between transverse and vertical closure groups (1.8% absolute difference; P = .5).
• The study's inclusive hernia definition means results cannot estimate true prevalence.

Conclusions:

• Surgeons may choose their preferred extraction site incision and closure method.
• Randomized comparisons are valuable for surgical technique modifications, with crossover cluster trials enabling efficient single-center studies.