Inguinal hernias in robotic-assisted laparoscopic radical prostatectomy: A surgeon's experience

Background/Introduction: The da Vinci robotic surgical system was developed to overcome the limitations of conventional laparoscopic surgery. Purpose/Aims: We retrospectively reviewed our experience in performing robot-assisted laparoscopic hernioplasty (RALH) during robot-assisted laparoscopic radical prostatectomy (RALP) based on a single surgeon's experience. Methods: From December 2005 to December 2008, a total of 100 patients with prostate cancer underwent RALPs by a single surgeon. We retrospectively reviewed the medical records and analyzed the patients' ages, body mass indices (BMI), levels of prostate-specific antigen, the biopsy percentage, the Gleason score and clinical stages of the biopsy specimens in 11 patients who had a RALP and a RALH simultaneously. The diagnosis of preoperative inguinal hernia (IH) was based on the results of a clinical physical examination, abdominal computed tomography or magnetic resonance imaging. The postoperative IHs were detected by the appearance of a protruding mass in the inguinal area on coughing, which was noticed during a physical examination. The total operative time, blood loss, type of the hernia, postoperative hospital stay, and the incidence of an IH after a RALP were evaluated. Results: Of the 100 patients, 89 (89%) received a RALP only, 11 underwent a RALP and a RALH simultaneously, 7% had a preoperative IH and 4% had a subclinical IH, which were found during operations. Three patients (3%) developed an IH during follow-up. There were no significant differences between the RALP group and RALP combined with the RALH group in terms of age, BMI, tumor stage, and operative time. Blood loss and the time required for urethrovesical anastomosis were significantly higher in the subclinical IH group than in the preoperative IH group. Conclusions: The incidence of an IH after a RALP was 3% with a mean follow-up of 32.42 +/- 11.76 months in this study. Subclinical IHs were relatively easier to notice during a RALP because of a high degree of pneumoperitoneum, the realistic 3D imaging and the steady view of the da Vinci robotic system. Thus, such a robotic procedure can be regarded to facilitate a more precise detection of occult IHs during a RALP, and it possibly decreases the incidence of IHs after a RALP. Copyright (C) 2011, Taiwan Surgical Association. Published by Elsevier Taiwan LLC. All rights reserved.