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Updated: Jun 6, 2025
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Incidence of Incisional Hernias after Single-Port Versus Multi-Port Robotic Radical Prostatectomy
J Corbin Norton1, Tyler Compher2, Luke Shumaker1
1Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Abstract:
To determine if single-port robotic-assisted radical prostatectomy (SP-RARP) has higher rates of incisional hernias when compared with multi-port robotic-assisted radical prostatectomies (MP-RARP). A retrospective, single-institution review of all consecutive robotic prostatectomy cases between January 2017 and December 2022. Analyzed multi-port and single-port robotic prostatectomies performed by two high-volume surgeons. Measured primary outcome for the development of incisional hernias, as defined by computed tomography imaging and clinical documentation. Multivariable logistic regression was used to determine the effect of the single-port approach on incisional hernia outcomes. A total of 493 patients were included in the study (320 SP-RARPs and 173 MP-RARPs). The overall incisional hernia rate was 8.5% (SP-RARP 8.1% vs MP-RARP 9.2%, p = 0.669). A median follow-up time was 16.6 months and a median time from procedure to hernia diagnosis was 7.4 months. SP-RARP had shorter OR time than the MP-RARP (236 minutes vs 276 minutes, p < 0.001). Patients who developed hernias had higher body mass index (BMIs) than those who did not (30.7 vs 29, p = 0.009). Multivariable logistic regression analysis revealed that patients with higher BMI (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.01-1.14) and a history of prior operation (OR 2.23, 95% CI 1.71-4.29) were more likely to develop incisional hernias. Cox regression analysis accounting for the difference in follow-up period demonstrated that SP-RARP 3.4× more likely to develop incisional hernias than MP-RARP (hazard ratio 3.38, 95% CI 1.50-7.58). Patients with higher BMIs and prior history of abdominal surgeries are at increased risk of developing postoperative incisional hernias. SP-RARP procedures confer a higher risk of postoperative incisional hernias.
Insights
Single-port robotic-assisted radical prostatectomy (SP-RARP) may increase the risk of incisional hernias compared to multi-port (MP-RARP). Higher BMI and prior surgeries are key risk factors for developing these hernias post-procedure.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Robotic-assisted radical prostatectomy is a standard treatment for prostate cancer.
- Single-port (SP-RARP) and multi-port (MP-RARP) approaches offer different surgical experiences.
- Incisional hernias are a potential complication following abdominal surgery.
Purpose of the Study:
- To compare the incidence of incisional hernias between SP-RARP and MP-RARP.
- To identify risk factors associated with incisional hernia development after robotic prostatectomy.
Main Methods:
- Retrospective review of 493 robotic prostatectomy cases (2017-2022).
- Analysis of incisional hernia rates based on CT imaging and clinical data.
- Multivariable logistic and Cox regression models used to assess risk factors and approach-specific outcomes.
Main Results:
- Overall incisional hernia rate was 8.5% (SP-RARP 8.1% vs. MP-RARP 9.2%, p=0.669).
- SP-RARP demonstrated shorter operative times (p < 0.001).
- Higher BMI (OR 1.07) and prior surgery history (OR 2.23) were linked to increased hernia risk. SP-RARP showed a 3.4x higher likelihood of incisional hernias (HR 3.38) after adjusting for follow-up.
Conclusions:
- Patients with higher BMI and previous abdominal surgeries face elevated risks of incisional hernias.
- Single-port robotic-assisted radical prostatectomy is associated with a higher risk of postoperative incisional hernias compared to the multi-port approach.
