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

Robotic-assisted radical prostatectomy (RARP) is associated with postoperative hernias at the extraction site, in the inguinal region, and at port sites. We explored hernia rates as well as risk factors for extraction site hernias after RARP based on specimen extraction location in this context. We queried a prospectively maintained database of all patients undergoing RARP from November 2006 to June 2023. We collected demographic features, oncologic and pathologic data, 30-day postoperative complications, and postoperative hernia incidence. Specimens were extracted via a midline periumbilical or a Pfannenstiel incision at the conclusion of the case per surgeon preference. Clinically relevant hernias were defined as hernias identified by symptoms or exam findings rather than imaging alone. Univariable and multivariable logistic regressions were used to identify risk factors for postoperative extraction site hernias. In total, 1465 patients underwent radical prostatectomy. Around 23.7% had specimen extraction via Pfannenstiel incision, whereas 76.3% were via extended midline periumbilical port. Patients with a Pfannenstiel extraction had a lower extraction site hernia rate (0.6% vs 7.4%) and clinically significant hernia rate (10.1% vs 14.5%, p = 0.04). On multivariable logistic regression, Hispanic race and Pfannenstiel extraction site were associated with significantly reduced odds of clinically relevant extraction site hernias. Use of a separate Pfannenstiel extraction site is associated with reduced risk of postoperative hernias for patients undergoing RARP. Surgeons should consider extracting the prostate via a Pfannenstiel incision during RARP given this potential benefit.