Pfannenstiel Extraction Site Reduces Postoperative Extraction Site Hernias after Robotic Radical Prostatectomy

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Robotic-assisted radical prostatectomy (RARP) is a common procedure for prostate cancer.
• Postoperative hernias, particularly at the extraction site, are a known complication of RARP.
• Risk factors and prevention strategies for these hernias require further investigation.

Purpose of the Study:

• To investigate hernia rates following RARP.
• To identify risk factors for extraction site hernias.
• To compare hernia incidence based on specimen extraction site (Pfannenstiel vs. midline periumbilical).

Main Methods:

• Retrospective analysis of a prospectively maintained database of 1465 RARP patients (November 2006 - June 2023).
• Data collected included demographics, oncologic details, and postoperative complications.
• Hernia incidence was assessed based on clinically relevant findings, and logistic regression identified risk factors.

Main Results:

• Specimen extraction via Pfannenstiel incision occurred in 23.7% of patients, while 76.3% used a midline periumbilical port.
• Pfannenstiel extraction was associated with a significantly lower extraction site hernia rate (0.6% vs. 7.4%) and clinically significant hernia rate (10.1% vs. 14.5%, p=0.04).
• Hispanic race and Pfannenstiel extraction site were independently associated with reduced odds of clinically relevant hernias.

Conclusions:

• Utilizing a Pfannenstiel incision for specimen extraction during RARP is linked to a decreased risk of postoperative hernias.
• Surgeons may consider the Pfannenstiel approach to mitigate hernia risk in RARP patients.
• This finding offers a potential modification to RARP technique to improve patient outcomes.