Aims To conduct a systematic review of the literature to identify the incidence and predictors of incisional hernia (IH) following robotic prostatectomy; and to provide recommendations to reduce the risk factors for IH development post-operatively. Methods The review was performed adhering to PRISMA guidelines, using search terms pertaining to robotic prostatectomy and incidence of IH via electronic databases (MEDLINE, EMBASE and Cochrane database). All original peer-reviewed articles in English were assessed for inclusion and quality by two independent reviewers. A quantitative analysis was conducted to evaluate methodologies, patient demographics, and the incidence of IH following robotic prostatectomy. Results We included 18 studies with a total of 17,965 patients. Average age of patients was 61.83 years and with an average BMI of 27.35. A transperitoneal, 6 port technique was the commonest robotic approach. Main sites of herniation included supraumbilical and lateral ports. The estimated incidence of IH was 1.49% (95% CI 1.28 to 4.25). Studies examining risk factors found age, high BMI, previous hernia repair and wound infections to be contributory to IH development. Only 6 studies reported surgical repair of IH with 3 patients requiring emergency operations. 5 studies reported reduction in IH following modifications in surgical technique. Conclusions Incisional hernias following robotic prostatectomy are a rare complication which can result in high patient morbidity. Our review demonstrated a variable incidence rate with increasing age and high BMI as common potential risk factors. Prevention strategies can result in reduction of IH; however, the studies were heterogenous with inconsistent data quality.
Robot-assisted surgery has become increasingly prevalent in surgical practice and is very commonly performed in urological cancers especially of the prostate gland. Robotic surgical techniques are safe and reproducible; however, they have their associated complications. Risk factors such as the nature of cancer, learning curve of the surgery, experience of the surgeon and patient characteristics have been implicated for potential complications. Complications can range from bleeding, infection, bowel injury, ureteric and nerve damage. Port site hernias (PSH) are an infrequent complication with a reported incidence varying from 0.2–4.8%. Although uncommon, they can result in high morbidity due to bowel incarceration and strangulation. We report two cases of PSH from our large district general hospital, both at the supraumbilical port site after robotic assisted radical prostatectomy (RARP). The first case presented with complete evisceration and strangulation of a segment of small bowel and the second with bowel incarceration and small bowel obstruction. Our cases highlight potentially rare but severe complications of RARP that should be promptly recognised and urgently treated to prevent significant patient morbidity and mortality.
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