Incisional Hernia after Robotic Urological Surgery

To summarize the current evidence on the incidence, risk factors, diagnosis, prevention, and management of incisional hernias following robotic urologic surgery.

Emerging evidence has highlighted both surgical and patient-related factors that influence the risk of incisional hernia. Surgical variables associated with higher incidence include midline extraction sites, midline trocar placement, prior abdominal surgery, non-bladed trocar use, and advanced tumor stage. Patient-specific contributors include visceral obesity and rectus diastasis. The financial impact is substantial, with U.S. healthcare expenditures for incisional hernia management estimated at $1.7 billion annually, underscoring the need to optimize surgical technique and patient selection to reduce this burden. Incisional hernia (IH) remains a significant postoperative complication, even with the advent of minimally invasive and robotic surgical techniques. Studies report a variable incidence of IH 0.2-6.3% following robotic prostatectomy, with rates as high as 27% in robotic nephrectomy depending on imaging modality and hernia definition. Diagnosis is commonly made with CT imaging, which remains the gold standard for preoperative planning. Although many IHs are asymptomatic, they may progress to incarceration, necessitating emergency repair with significant morbidity and mortality. Risk factors for IH are multifactorial and include patient-related variables such as obesity, smoking, COPD, diabetes, and rectus diastasis, as well as surgical factors including trocar size and type, extraction site location, and fascial closure technique. Notably, midline and bladed trocar placements are associated with higher hernia risk, while Pfannenstiel extraction and use of non-bladed trocars may be protective. Management strategies remain inconsistent, and preventive measures such as prophylactic mesh, proven effective in general surgery, have yet to be evaluated in urologic robotic procedures. This review summarizes the current literature on IH following robotic urologic surgery, with emphasis on incidence, risk factors, diagnostic modalities, preventive techniques, and potential areas for future research. Given the growing use of robotics in urology and the rising economic burden of IH, better understanding of prevention and early intervention is essential to improving outcomes and reducing healthcare costs.