Off-midline versus supraumbilical specimen extraction sites in robot-assisted radical prostatectomy

To compare two different specimen extraction sites (SES) (off-midline [OM] vs. supraumbilical) for the incidence of incisional hernias (IHs) and to evaluate different risk factors for their occurrence after robot-assisted radical prostatectomy.

In our clinic, prior to June 2019, SES were supraumbilical; thereafter, they were OM. The primary endpoint was to determine the need for IH repair according to the chosen SES. Additionally, we evaluated possible risk factors. Statistical analysis was performed with the Mann-Whitney U test, Chi-squared, binary and multiple logistic regression analysis, and log-rank testing.

Data from 914 consecutive patients (April 2018-September 2020) were used for the final analysis; of these, 439 (48%) had a supraumbilical and 475 (52%) an OM SES. After a median follow-up of 35.0 months, 50 (5.5%) patients developed an IH: 42 (9.5%) from the supraumbilical group and eight (1.7%) from the OM group (P < 0.001, odds ratio 5.495; 95% confidence interval 2.42-12.48). Median time to IH repair was 7.9 months: 0.5 in the OM and 10.1 in the supraumbilical group (P = 0.026). There were no other associations with clinico-pathological patient data.

The SES in robot-assisted radical prostatectomy seems to play an important role in the development of postoperative IHs, with the OM approach potentially offering an advantage. Additionally, IHs appear to occur earlier with an OM than with a supraumbilical approach.