Are we failing to consent to an increasingly common complication? Incisional hernias at robotic prostatectomy

Timm, Brennan; O'Connor, Ellen; Bolton, Damien; Liodakis, Peter

doi:10.1007/s11701-020-01063-w

Cited by 6 publications

(12 citation statements)

References 19 publications

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“…Recent large sample size cohort studies reported that the incisional hernia incidence rate was higher with minimally invasive radical prostatectomy, including RARP, than with traditional open radical prostatectomy [3,4]. The incidence rate of incisional hernia following RARP has been reported to be 4.4-8.6% [8][9][10][11]. It is speculated that the incisional hernia occurrence rate after RARP was higher than that after open prostatectomy, because the camera trocar and specimen extraction site were placed above or in the umbilical region in RARP, where the muscles are known to be weaker, as opposed to the infraumbilical incision in open prostatectomy [4].…”

Section: Discussionmentioning

confidence: 99%

Enhanced-view totally extraperitoneal repair in a patient with incisional hernia after robot-assisted laparoscopic radical prostatectomy: a case report

et al. 2022

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Background Although laparoscopic incisional hernia repair, especially laparoscopic intraperitoneal onlay mesh, is a widely used technique, it can cause serious complications, including mesh erosion, adhesive bowel obstruction, and chronic pain. The enhanced-view totally extraperitoneal (eTEP) technique has been reported to prevent such complications by placing the mesh in the retrorectus space. Here, we report the case of a patient with post-robot-assisted laparoscopic radical prostatectomy (RARP) incisional hernia repaired using the eTEP technique. Case presentation A 67-year-old man, who underwent RARP for prostate cancer 4 years ago developed an incisional hernia. Abdominal computed tomography showed the presence of an epigastric incisional hernia measuring 4 cm long and 3.7 cm wide. We performed an eTEP repair. We closed the hernia defect using a 0 barbed suture and placed a self-gripping mesh measuring 20 cm long and 15 cm wide in the developed retrorectus space with no fixation. There were no postoperative complications, and the patient was discharged on postoperative day 2. Conclusions eTEP repair is considered an extremely effective surgical treatment option for incisional hernias because of its few resulting postoperative mesh-and-tacker-related complications.

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Section: Discussionmentioning

confidence: 99%

Enhanced-view totally extraperitoneal repair in a patient with incisional hernia after robot-assisted laparoscopic radical prostatectomy: a case report

et al. 2022

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“…Examining hernia repairs, a recent study by Timm et al [6] looked at the occurrence of incisional hernias in 186 RARP patients and found a hernia rate of 8.6% at the supraumbilical specimen extraction site and 1.1% incidental hernia at a lateral port site. Risk factors were previous abdominal surgery, adhesiolysis, history of smoking, and obesity.…”

Section: Discussionmentioning

confidence: 99%

Surgical Complications Requiring Intervention in Open versus Minimally Invasive Radical Prostatectomy

et al. 2021

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Introduction: Injuries to surrounding structures during radical prostatectomy (RP) are rare but serious complications. However, it remains unknown if injuries to intestines, rectum, or vascular structures occur at different rates depending on the surgical approach. Methods: We compared the frequency of these outcomes in open RP (ORP) and minimally invasive RP (MIS-RP) using the national American College of Surgeons National Surgical Quality Improvement Program database (2012–2017). Along with important metrics of clinical and surgical outcomes, patients were identified as undergoing surgical repair of small or large bowel, vascular structures, or hernias based on Current Procedural Terminology codes. Results: In our propensity matched analysis, a total of 13,044 patients were captured. Bowel injury occurred more frequently in ORP than in MIS-RP (0.89 vs. 0.26%, p < 0.01). By intestinal segment, rectal and large bowel injuries were more common in ORP than MIS-RP (0.41 vs. 0.11% and 0.31 vs. 0.05%, both p < 0.01). However, there was no statistically significant difference between the groups for small bowel injury (0.17 vs. 0.11%, p = 0.39). Vascular injury was more common in MIS-RP (0.18 vs. 0.08%, p = 0.08). Hernias requiring repair were only identified in the MIS-RP group (0.12%). Conclusion: When considering surgical approach, rectal and large bowel injuries were more common in ORP, while vascular injuries and hernia repair were more common in MIS-RP. Our findings can be used in counseling patients and identifying risk factors and strategies to reduce these complications.

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“…The inclusion and exclusion criteria applied in the four studies analysing data retrospectively are very varied across the reports but are very clearly specified. Timm et al (2020) and Seveso et al (2017) only included those patients who had a robotic-assisted laparoscopic prostatectomy, whereas the papers by Damani et al (2020) and Lambertz et al (2017) looked at all specialities that had undergone any laparoscopic surgery. No other exclusions were noted, and a wide variety of patients were looked at, regardless of any other comorbidities.…”

Section: Critical Appraisalmentioning

confidence: 99%

“…The data analysis was performed using computer software tools for four of the papers, the remaining study (Timm et al 2020) providing a detailed account of the analysis process. The use of computer packages reduces the risk of bias by not allowing the manipulation of results, thus increasing rigour (Crombie 2014).…”

Section: Critical Appraisalmentioning

confidence: 99%

Port-site hernias in patients undergoing laparoscopic and/or robotic surgery: Can they be prevented?

Richards

2022

Journal of Perioperative Practice

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As laparoscopic surgery advances into robotic surgery, there still remains the occurrence of port-site hernias. This can have severe consequences for the patient, including needing further surgery such as bowel resection. This has an impact on both patient and the National Health Service as the stay in hospital is prolonged, increasing the demand on staff and creating more expense to the National Health Service. This literature review explores the prevalence of port-site hernias and discovers the recommendations in preventive measures. Findings include the benefit of using non-bladed trocars and further studies need to be conducted into the association between smaller or larger ports and port-site hernias.

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Are we failing to consent to an increasingly common complication? Incisional hernias at robotic prostatectomy

Cited by 6 publications

References 19 publications

Enhanced-view totally extraperitoneal repair in a patient with incisional hernia after robot-assisted laparoscopic radical prostatectomy: a case report

Enhanced-view totally extraperitoneal repair in a patient with incisional hernia after robot-assisted laparoscopic radical prostatectomy: a case report

Surgical Complications Requiring Intervention in Open versus Minimally Invasive Radical Prostatectomy

Port-site hernias in patients undergoing laparoscopic and/or robotic surgery: Can they be prevented?

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