Robotic radical prostatectomy with concomitant repair of inguinal hernia: is it safe?

Abstract

Robotic radical prostatectomy (RARP) is well established as a safe and effective treatment for prostate cancer. According to published studies, patients undergoing RARP are at increased risk of being diagnosed with an inguinal hernia after RARP and are four times more likely to have an inguinal hernia repair (IHR) following RARP. Several studies have demonstrated the effectiveness and safety of IHR during RARP. Overall, it has been observed that IHR adds on average, 12-15 min in total surgical time and there were no significant differences between RARP with or without IHR with respect to postoperative complications. This study analyzes a large series of patients undergoing RARP (1100) and compares them to a group that underwent RARP with IHR (39). Between December 2008 and January 2015, 1139 patients underwent RARP at Florida Hospital in Celebration, FL. Of the total patients, 39 underwent concomitant IHR. All procedures were performed by the same surgeons (urologist and general surgeon), using the same techniques of RARP and TAPP inguinal hernia repair. After 30 days, the differences were evaluated between groups regarding surgical time, EBL and postoperative complications. The average age of patients undergoing the procedure was 61.65 years. The mean procedure time was approximately 120 min (min), with an additional period of 68 min for IHR (mean = 188; p = 0.0001). There was a significant difference in BMI between the groups, 28.3 kg/m for patients undergoing RARP and 26.8 kg/m for those who underwent RARP and IHR (p = 0.028). The EBL averaged 110.87 mL, with no significant difference between groups (p = 0371). There was no significant association between clinical stage of the patient and the type of procedure performed (p = 12:35). There was no significant difference in the presence of comorbidities and the operation preformed. There were 61 events recorded postoperatively, 57 (5.2%) among patients who underwent only RARP and 4 (10.26%) among those who had both. Taken together, the small amounts of complications in both groups prevent statistical significance. This study compared two groups of patients undergoing RARP: those with IHR and those without. Our study demonstrated an increase in surgical time; however, there was no increase in postoperative complications. From the data presented, we suggest that the performance of both procedures concomitantly is feasible and safe.

Incidence, Predictive Factors and Preventive Measures for Inguinal Hernia following Robotic and Laparoscopic Radical Prostatectomy: A Systematic Review

“…Herniorrhaphy, onlay mesh totally extraperitoneal or transabdominal preperitoneal Celik, 27 S anchez-Ortiz, 13 Do, 28 Kyle, 29 Teber, 30 Rogers, 31 Nakamura 32 et al Herniorrhaphy mesh or mesh plug Joshi, 33…”

Simultaneous robot‐assisted laparoscopic radical prostatectomy and inguinal hernia repair using a polypropylene mesh: Report of two cases

“…2 Several studies have reported on RARP combined with R-TAPP, and a growing body of evidence supports the safety and feasibility of this combination. 3 Similarly, we report two cases in which RARP and R-TAPP were performed simultaneously. The unique aspect of this report is that in one case, extensive incision of the peritoneum during pelvic lymph node dissection made it impossible to close the peritoneal flap, but hernia repair was successfully completed by sewing an artificial polypropylene mesh over the hernia area in a circumferential fashion.…”

Inseparable interaction of the prostate and inguinal hernia

“…Moreover, Rogers et al . reported that although TAP hernioplasty during RARP increased surgical time, there was no increase in postoperative complications, suggesting that concomitant performance of both procedures is feasible and safe …”

“…Moreover, Rogers et al reported that although TAP hernioplasty during RARP increased surgical time, there was no increase in postoperative complications, suggesting that concomitant performance of both procedures is feasible and safe. 23 Conversely, Ludwig et al compared concomitant laparoscopic TEP and RARP with similar combined IH repair with LRP. Following standard extraperitoneal RARP with pelvic lymph node dissection, surgeons performed TEP using the same ports.…”