Mp52-18 Specimen Extraction via a Pfannenstiel Incision Associated With a Lower Risk of Incisional Hernia and Improved Cosmesis After Robotic Radical Prostatectomy

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II (MP52)1 May 2024MP52-18 SPECIMEN EXTRACTION VIA A PFANNENSTIEL INCISION ASSOCIATED WITH A LOWER RISK OF INCISIONAL HERNIA AND IMPROVED COSMESIS AFTER ROBOTIC RADICAL PROSTATECTOMY Ricardo Sanchez-Ortiz and Claudia Bernaschina-Rivera Ricardo Sanchez-OrtizRicardo Sanchez-Ortiz and Claudia Bernaschina-RiveraClaudia Bernaschina-Rivera View All Author Informationhttps://doi.org/10.1097/01.JU.0001008864.84854.b7.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Observational studies suggest that minimally invasive radical prostatectomy (RP) may be associated with a three-fold higher risk of incisional hernias compared with open RP (5.3% vs. 1.9%). Data from the colorectal surgery literature suggest that moving the specimen extraction incision to the lower pelvis may reduce the incidence of incisional hernias. We evaluated the risk of incisional hernia after changing our extraction incision to a small Pfannenstiel incision. METHODS: We performed a retrospective review of 600 men consecutive men with prostate cancer (PCa) managed with robotic RP over a 3-year period, the initial 345 underwent specimen extraction via a supraumbilical transverse incision and the subsequent 248 with a Pfannenstiel (PF) incision with the camera port placed through the umbilicus. Patients who underwent pelvic fascia-sparing RP and those with less than 6 months follow-up were excluded. The risk of an incisional hernia, scar characteristics (length and width), and clinical variables were compared between groups. SPSS was used for statistical analysis. RESULTS: After a median follow-up of 16 months, incisional hernias were more common with upper abdominal specimen extraction incisions compared with Pfannenstiel incisions (1.7% (6/345) vs. zero, p<0.05, HR: 1.39). The average maximal scar length was smaller with a PF incision compared with an upper abdominal incision (3.8 PF group vs. 5.6 cm, p<0.02, n=100) despite no differences in prostate size between groups (48.8 vs. 48 PF grams). There were no differences between groups regarding scar width (2.2 cm PF vs. 2.5 cm, n=100), mean BMI (28.8 vs 28.6 PF), age (60.8 vs. 60 years PF), serum PSA (4.7 vs. 6.4 ng/ml PF), operative time (151 vs. 145 minutes PF), blood loss (208 vs. 197 cc PF), or history of diabetes mellitus (overall 14.8%). CONCLUSIONS: Prostate specimen extraction via a small Pfannenstiel incision during robotic RP was associated with a lower risk of incisional hernia and improved cosmesis compared to an upper abdominal transverse incision without higher operative times or blood loss. Given the easier fascial closure with a Pfannenstiel incision, particularly in high-BMI patients, we have adopted this approach for all patients. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e860 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Ricardo Sanchez-Ortiz More articles by this author Claudia Bernaschina-Rivera More articles by this author Expand All Advertisement PDF downloadLoading ...