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Updated: Sep 15, 2025
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Rectus diastasis is a risk factor for incisional hernia after robot assisted laparoscopic radical prostatectomy for
Shusaku Honma1, Kana Ishikawa2, Takashi Kumode2
1Department of Surgery, Kobe City Medical Center West Hospital, 2-4, Ichibancho, Nagataku, Kobe, 653-0013, Hyogo, Japan. shomma74@kuhp.kyoto-u.ac.jp.
Purpose:
This study aimed to investigate the association between rectus diastasis (RD) and incisional hernia (IH) following robot-assisted laparoscopic radical prostatectomy (RARP).
Methods:
We retrospectively reviewed all patients who underwent RARP for prostate cancer at our hospital between January 2017 and December 2023. All participants were required to undergo computed tomography imaging prior to RARP and at least once no less than five months after RARP to assess RD and IH, respectively. RD was defined as a widening of the linea alba exceeding 2 cm. A backward stepwise regression modeling was used to construct a multivariate logistic model. The cumulative incidence of IH was calculated and compared between patients with and without RD using the Kaplan-Meier method.
Results:
Among 145 eligible patients, 45 (31.0%) developed IH. Multivariable logistic regression analysis identified RD (Odds ratio 4.03, 95% confidence interval 1.92-8.48) as an independent risk factor associated with IH after adjusting for pre-existing primary umbilical hernia, body mass index, specimen weight, and surgical site complication. The cumulative incidence of IH was significantly higher in patients with RD than those without.
Conclusion:
RD is a significant risk factor for IH after RARP. Vertical midline incisions at the specimen extraction site should be avoided in patients with RD whenever possible.
