Abstract
Introduction
Robotic-assisted laparoscopic prostatectomy (RALP) has become one of the most common laparoscopic procedures in the United States, with over 80,000 cases performed yearly. There is increasing awareness that extraction site ventral hernias (ESVH) are an important cause of morbidity after laparoscopic resective surgery. However, there is no data in the literature concerning ESVH after RALP. The purpose of this study is to report our experience with this novel ESVH and our results with its laparoscopic (LAP) repair.
Methods
The charts of all patients subjected to LAP VH repair at the City of Hope National Medical Center between 2005 and 2009 were retrospectively reviewed. Only patients undergoing LAP ESVH after RALP were included in the study. Relevant data analyzed included patient demographics, operative parameters, complications, and recurrence.
Results
A total of 42 consecutive male patients were identified, with a median age of 65 years (range 46–81). The median time from RALP to ESVH repair was 10 months (range 1–43). All hernias were periumbilical and all were symptomatic. A laparoscopic left lateral approach was used in all cases. The median operative time was 91 min (range 61–162). The median defect area was 64 cm2 (range 4–176), which was repaired with polytetrafluoroethylene (PTFE) (18 cases) or Marlex composite mesh (24 cases) with a 5-cm overlap. The estimated blood loss (EBL) was minimal in all cases. The median hospital stay was 1 day (range 0–4). Minor complications occurred in 14% of cases. There was no mortality and the recurrence rate was 0%.
Conclusions
ESVH after RALP are likely to become a common cause of abdominal wall morbidity in the near future. A laparoscopic repair is safe and effective. Prospective studies are needed in order to further investigate ESVH and ways to reduce its incidence.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Binder J, Kramer W (2001) Robotically-assisted laparoscopic radical prostatectomy. BJU Int 87:408–410
Mavrich Villavicencio H, Esquena S, Palou Redorta J, Gómez Ruíz J (2007) Robotic radical prostatectomy: overview of our learning curve. Actas Urol Esp 31:587–592
Patel VR, Palmer KJ, Coughlin G, Samavedi S (2008) Robot-assisted laparoscopic radical prostatectomy: perioperative outcomes of 1500 cases. J Endourol 22:1299–2305
Badani KK, Kaul S, Menon M (2007) Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Cancer 110:1951–1958
Ahlering TE, Woo D, Eichel L, Lee DI, Edwards R, Skarecky DW (2004) Robot-assisted versus open radical prostatectomy: a comparison of one surgeon’s outcomes. Urology 63:819–822
Bentas W, Wolfram M, Jones J, Bräutigam R, Kramer W, Binder J (2003) Robotic technology and the translation of open radical prostatectomy to laparoscopy: the early Frankfurt experience with robotic radical prostatectomy and one year follow-up. Eur Urol 44:175–181
El-Hakim A, Leung RA, Tewari A (2006) Robotic prostatectomy: a pooled analysis of published literature. Expert Rev Anticancer Ther 6:11–20
Stephenson RA (2002) Prostate cancer trends in the era of prostate-specific antigen. An update of incidence, mortality, and clinical factors from the SEER database. Urol Clin North Am 29:173–181
Earle D, Seymour N, Fellinger E, Perez A (2006) Laparoscopic versus open incisional hernia repair: a single-institution analysis of hospital resource utilization for 884 consecutive cases.. Surg Endosc 20:71–75
Müller-Riemenschneider F, Roll S, Friedrich M, Zieren J, Reinhold T, von der Schulenburg JM, Greiner W, Willich SN (2007) Medical effectiveness and safety of conventional compared to laparoscopic incisional hernia repair: a systematic review. Surg Endosc 21:2127–2136
Laurent C, Leblanc F, Bretagnol F, Capdepont M, Rullier E (2008) Long-term wound advantages of the laparoscopic approach in rectal cancer. Br J Surg 95:903–908
Singh R, Omiccioli A, Hegge S, McKinley C (2008) Does the extraction-site location in laparoscopic colorectal surgery have an impact on incisional hernia rates? Surg Endosc 22:2596–2600
Winslow ER, Fleshman JW, Birnbaum EH, Brunt LM (2002) Wound complications of laparoscopic vs open colectomy. Surg Endosc 16:1420–1425
Bird VG, Au JK, Sandman Y, De Los Santos R, Ayyathurai R, Shields JM (2009) Comparison of different extraction sites used during laparoscopic radical nephrectomy. J Urol 181:1565–1570
Fischer B, Engel N, Fehr J-L, John H (2008) Complications of robotic assisted radical prostatectomy. World J Urol 26:595–602
Wolter A, Rudroff C, Sauerland S, Heiss MM (2009) Laparoscopic incisional hernia repair: evaluation of effectiveness and experiences. Hernia 13:469–474
Tisdale BE, Kapoor A, Hussain A, Piercey K, Whelan JP (2007) Intact specimen extraction in laparoscopic nephrectomy procedures: Pfannenstiel versus expanded port site incisions. Urol 69:241–244
Troxel SA, Das S (2005) Incisional hernia following hand-assisted laparoscopic surgery for renal cell cancer. JSLS 9:196–198
Tonouchi H, Ohmori Y, Kobayashi M, Kusunoki M (2004) Trocar site hernia. Arch Surg 139:1248–1256
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ho, J., Pigazzi, A. Laparoscopic repair of extraction site ventral hernia after robotic prostatectomy: institutional experience with 42 consecutive cases. Hernia 15, 673–676 (2011). https://doi.org/10.1007/s10029-011-0836-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-011-0836-7