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Peixoto N, Grobet-Jeandin E, Schoofs F, Windisch O, Iselin C, Benamran D. Long term efficacy of prosthetic inguinal herniorrhaphy concomitant with robot-assisted laparoscopic radical prostatectomy. World J Urol 2023; 41:3169-3174. [PMID: 37755521 PMCID: PMC10632196 DOI: 10.1007/s00345-023-04625-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023] Open
Abstract
PURPOSE Patients who undergo robot-assisted laparoscopic radical prostatectomy (RARP) may present concurrent or secondary inguinal hernia (IH). Surgical repair of IH simultaneously with RARP has been reported. We aimed to assess the long-term efficacy of concurrent prosthetic IH repair with RARP. METHODS Data for consecutive patients undergoing concurrent IH repair with RARP for localized prostate cancer at our institution between 2006 and 2017 were retrospectively analysed. Patients were matched based on age, BMI, and year of surgery, with patients undergoing RARP alone. IH repair was performed with a polyester mesh. Efficacy of IH repair was the primary outcome. Patient characteristics, perioperative data, recurrence and treatment were recorded. RESULTS A total of 136 men were included, 50% treated by RARP and concurrent IH, 50% by RARP alone. Mean age was 65 years (SD 6) and mean BMI 26.8 (SD 2.5). IH was diagnosed preoperatively in 42 patients (62%) or intraoperatively in 26 patients (38%). A total 18 patients (26%) had bilateral hernias and 50 patients had unilateral hernias (right 31%, left 43%). There was no significant difference between the two groups regarding perioperative data. The herniorrhaphy added 34 min to the operative time (p < 0.001). After a mean follow-up of 106 months [SD 38], 9 patients (13%) presented recurrence of IH, with a mean time to recurrence of 43 months [SD 35]. Age was significantly associated with IH recurrence (p = 0.0007). CONCLUSION Concomitant IH repair and RARP appear to be a safe procedure with good long-term safety and efficacy, without significantly increasing morbidity.
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Affiliation(s)
- Nelson Peixoto
- Division of Urology, Geneva University Hospitals, 1211 Genève 14, Geneva, Switzerland
| | | | - Fabian Schoofs
- Division of Urology, Geneva University Hospitals, 1211 Genève 14, Geneva, Switzerland
| | - Olivier Windisch
- Division of Urology, Geneva University Hospitals, 1211 Genève 14, Geneva, Switzerland
| | - Christophe Iselin
- Division of Urology, Geneva University Hospitals, 1211 Genève 14, Geneva, Switzerland
| | - Daniel Benamran
- Division of Urology, Geneva University Hospitals, 1211 Genève 14, Geneva, Switzerland.
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Chiacchio G, Beltrami M, Cicconofri A, Nedbal C, Pitoni L, Fuligni D, Maggi M, Milanese G, Galosi AB, Castellani D, Giulioni C. Simultaneous Inguinal Hernia Repair with Monofilament Polypropylene Mesh during Robot-Assisted Radical Prostatectomy: Results from a Single Institute Series. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050820. [PMID: 37241052 DOI: 10.3390/medicina59050820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Inguinal hernia (IH) is a usual finding in men with prostate cancer (PCa) due to their similar risk factors, such as age, gender, and smoking. This study aims to present a single institution's experience with simultaneous IH repair (IHR) and robotic-assisted radical prostatectomy (RARP). Materials and Methods: We retrospectively reviewed 452 patients who underwent RARP between January 2018 and December 2020. A total of 73 patients had a concomitant IHR with a monofilament polypropylene mesh. Patients with bowel in the hernia sac or recurrent hernia were excluded. Results: The median age and the American Society of Anesthesiologists (ASA) score were 67 years (inter-quartile range (IQR) 56-77) and 2 (IQR 1-3), respectively. The median prostate volume and preoperative prostate-specific antigen (PSA) were 38 mL (IQR 25.0-75.2) and 7.8 ng/mL (IQR 2.6-23.0), respectively. The surgery was successfully performed in all cases. The median overall and IHR operative time were 190.0 (IQR 140.0-230.0) and 32.5 (IQR 14.0-40.0) minutes, respectively. The median estimated blood loss and length of hospital stay were 100 mL (IQR 10-170) and 3 days (IQR 2-4), respectively. Only five (6.8%) minor complications occurred after surgery. At the 24-month follow-up, no cases of mesh infection, seroma formation, or groin pain were recorded. Conclusions: This study confirmed the safety and efficacy of performing simultaneous RARP and IHR.
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Affiliation(s)
- Giuseppe Chiacchio
- Urology Unit, Faculty of Medicine, School of Urology, Azienda Ospedaliera Universitaria Delle Marche, 60127 Ancona, Italy
| | - Mattia Beltrami
- Urology Unit, Faculty of Medicine, School of Urology, Azienda Ospedaliera Universitaria Delle Marche, 60127 Ancona, Italy
| | - Andrea Cicconofri
- Urology Unit, Faculty of Medicine, School of Urology, Azienda Ospedaliera Universitaria Delle Marche, 60127 Ancona, Italy
| | - Carlotta Nedbal
- Urology Unit, Faculty of Medicine, School of Urology, Azienda Ospedaliera Universitaria Delle Marche, 60127 Ancona, Italy
| | - Lucia Pitoni
- Urology Unit, Faculty of Medicine, School of Urology, Azienda Ospedaliera Universitaria Delle Marche, 60127 Ancona, Italy
| | - Demetra Fuligni
- Urology Unit, Faculty of Medicine, School of Urology, Azienda Ospedaliera Universitaria Delle Marche, 60127 Ancona, Italy
| | - Martina Maggi
- Department of Maternal Infant and Urologic Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Giulio Milanese
- Urology Unit, Faculty of Medicine, School of Urology, Azienda Ospedaliera Universitaria Delle Marche, 60127 Ancona, Italy
| | - Andrea Benedetto Galosi
- Urology Unit, Faculty of Medicine, School of Urology, Azienda Ospedaliera Universitaria Delle Marche, 60127 Ancona, Italy
| | - Daniele Castellani
- Urology Unit, Faculty of Medicine, School of Urology, Azienda Ospedaliera Universitaria Delle Marche, 60127 Ancona, Italy
| | - Carlo Giulioni
- Urology Unit, Faculty of Medicine, School of Urology, Azienda Ospedaliera Universitaria Delle Marche, 60127 Ancona, Italy
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Melhem M, Burki J, Algurabi O, Gilani S, Ghumman F, Sheriff M, Wani M, Haddad R, Madaan S. The safety and feasibility of simultaneous robotic repair of an inguinal hernia during robotic-assisted laparoscopic prostatectomy: a systematic review and meta-analysis. Scand J Urol 2022; 56:197-205. [PMID: 35665635 DOI: 10.1080/21681805.2022.2065358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE This study intended to assess the safety and feasibility of performing concurrent robotic-assisted laparoscopic prostatectomy (RALP) and robotic inguinal hernia repair (RIHR). METHOD We systematically searched the PubMed, Embase and Cochrane Library database up to the year 2020 to identify studies that assessed patients who underwent RALP and RIHR in the same settings. RESULTS Thirteen studies were considered suitable for a systematic review and seven for Meta-analysis. RALP and RIHR were associated with significantly longer operative time. RIHR added on average 26 min to the operation time (8, 45 95% CI, p = 0.005, I2 97%). Concurrent RALP and RIHR was not associated with a higher incidence of blood loss (-13, 6 95% CI, p = 0.43, I2 18%), length of stay (-0.08, 0.06 95% CI, p = 0.73, I2 0%) or early postoperative complications. CONCLUSION Concurrent robotic repair of an inguinal hernia during RALP appears feasible and safe. Urologists should be encouraged to repair hernias encountered during RALP keeping in mind possible complications including wound infection, mesh infection, chronic inguinal pain and recurrence of hernia.
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Affiliation(s)
- Motaz Melhem
- Department of Urology, Medway Maritime Hospital, Kent, United Kingdom
| | - Javid Burki
- Department of Urology, Medway Maritime Hospital, Kent, United Kingdom
| | - Omar Algurabi
- Department of Urology, Medway Maritime Hospital, Kent, United Kingdom
| | - Sayed Gilani
- Department of Urology, Medway Maritime Hospital, Kent, United Kingdom
| | - Faisal Ghumman
- Department of Urology, Medway Maritime Hospital, Kent, United Kingdom
| | - Matin Sheriff
- Department of Urology, Medway Maritime Hospital, Kent, United Kingdom
| | - Mudassir Wani
- Department of Urology Glangwili Hospital, Wales, United Kingdom
| | - Ra'ed Haddad
- Department of Urology, Oxford University Hospitals, Oxford, United Kingdom
| | - Sanjeev Madaan
- Department of Urology and Nephrology, Darent Valley Hospital, Dartford, United Kingdom.,Institute of Medical Sciences, Canterbury Christchurch University, Canterbury, United Kingdom
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Ivos M, Wilhelm C, Sharma P. Evaluating the incidence, management, and recurrence of inguinal hernia during robotic prostatectomy: A literature review. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221095662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Robotic radical prostatectomy (RARP) is a well-established treatment for localised prostate adenocarcinoma. The benefits of this minimally invasive technique include shortened operative time and improved patient recovery. However, the development of inguinal hernia (IH) before, during, and following RARP has been reported. The aim of this study is to evaluate the incidence, management, and recurrence of IHs in patients undergoing RARP for prostate cancer. Methods: A literature search was conducted using the PubMed database from August 2007 to October 2020 using the keywords ‘robotic prostatectomy’ and ‘inguinal hernia’. Studies evaluating the incidence and recurrence of IH in patients undergoing RARP were identified and included. The initial search identified 77 articles. After excluding one duplicate, six case reports, three editorial comments, four articles not in English, eight review articles, and 14 studies that did not mention hernia incidence, 41 studies were included in our final literature review. Results: Concomitant IH repair (IHR) during RARP resulted in decreased symptomatic hernia recurrence during the follow-up period. When compared to patients who had not undergone hernia repair, the patients who underwent IHR during RARP did not experience greater complications in the postoperative period. Conclusions: Patients that undergo an intraoperative IHR during RARP did not experience significant adverse postoperative complications. Although operative time can slightly increase compared to RARP alone, we recommend a thorough preoperative physical examination in all patients scheduled to undergo RARP to evaluate for IH in addition to a thorough discussion with the patient of the risks and benefits of intraoperative repair. Level of evidence: Not applicable
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Affiliation(s)
- Mia Ivos
- School of Medicine, Texas Tech University Health Sciences Center, USA
| | | | - Pranav Sharma
- Department of Urology, School of Medicine, Texas Tech University Health Sciences Center, USA
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Bedir F, Altay MS, Kocatürk H, Bedir B, Hamidi N, Canda AE. Concurrent Inguinal Hernia Repair During Robot-Assisted Transperitoneal Radical Prostatectomy: Single Center Experience. ROBOTIC SURGERY (AUCKLAND) 2021; 8:39-44. [PMID: 34917689 PMCID: PMC8666846 DOI: 10.2147/rsrr.s339892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/27/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate outcomes of concurrent inguinal hernia (IH) repair with mesh during transperitoneal robot-assisted radical prostatectomy (RARP). MATERIAL AND METHODS Data of 26 patients (31 procedures) undergoing IH repair concurrently with RARP between January 2017 and January 2020 were evaluated retrospectively. Patients' demographics, intraoperative and postoperative variables were recorded. Patients were assessed based on prostate-specific antigen recurrence, IH recurrence, mesh infection, seroma formation and groin pain quarterly in the first year, and every six month thereafter. RESULTS The median age was 64.5 years in our population. IH was detected preoperatively in 46.2% of patients (n = 12) and intraoperatively in 53.8% (n = 14). Twenty-one (80.8%) patients (11 of them had right IH and 10 of them had left IH) had unilateral hernias and 5 patients (19.2%) had bilateral hernias. Twenty-three (88.4%) IHs were direct, three (11.6%) were indirect. The median operative time and estimated blood loss were 192.5 (range: 140-250) min and 100 (range: 10-170) mL, respectively. The median duration of IH repair, time of drainage, length of hospitalization, and catheterization were 32.5 (range: 14-40) min. 2 (range: 2-6) days, 6 (range: 5-8) days and 7 (range: 5-7) days, respectively. No perioperative complication due to RARP or IH repair was observed. During a median follow-up time was 18 months, no scrotal hematoma, seroma formation or mesh infection was identified. CONCLUSION IH repair performed during the same session at RARP is a safe and applicable procedure.
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Affiliation(s)
- Fevzi Bedir
- Department of Urology, Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | | | - Hüseyin Kocatürk
- Department of Urology, Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Banu Bedir
- Department of Public Health, Aziziye District Health Directorate, Erzurum, Turkey
| | - Nurullah Hamidi
- Department of Urology, Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Abdullah Erdem Canda
- Department of Urology, School of Medicine, Koç University Hospital, Istanbul, Turkey
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Bertolo R, Mir Maresma M, Bove P, Rubio-Briones J, Ramírez-Backhaus M. The relationship between inguinal hernia and minimally-invasive surgery for prostate cancer: A systematic review of the literature. Actas Urol Esp 2020; 44:131-138. [PMID: 32057461 DOI: 10.1016/j.acuro.2019.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/18/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We aimed to perform a systematic review about the relationship between inguinal hernia and surgery for prostate cancer. BACKGROUND Diagnosis of abdominal wall defects and prostate cancer may be either synchronous or metachronous. The convenience and safety of combined prostatectomy and hernioplasty, the incidence of hernias after prostatectomy and the feasibility of prostatectomy in patients with previous laparoscopic hernioplasty are still debated. METHODS PubMed and Embase were queried by dedicated search strings. Two researchers independently reviewed the pooled references and selected the articles of interest, including reviews. RESULTS Sixty-five studies were evaluated, 22 of them analysed the feasibility and the outcomes of a combined surgery, namely one-stage radical prostatectomy and herniorrhaphy or hernioplasty. Literature evidences support the combined intervention to patients suffering from an inguinal hernia and a prostate cancer amenable of radical prostatectomy. Sixteen studies addressing the potential increase in the occurrence of inguinal hernia after radical prostatectomy were evaluated. Approximately 15% of patients who undergo retro-pubic radical prostatectomy will develop inguinal hernia. It is suggested that the incidence might be lower in laparoscopic prostatectomy series, particularly in case of transperitoneal approach. The median time to the appearance of the hernia is around 6 months. After evaluation of 14 studies, it is concluded that laparoscopic hernioplasty does not preclude prostatectomy but hinders further pelvic surgery. CONCLUSIONS One-stage combined hernioplasty and radical prostatectomy may be accepted except in cases of lymph-nodes dissection and/or positive hydro-distress test of the urethro-vesical anastomosis. Accurate patient's counselling and dedicated consent form are mandatory, in the setting of an experienced multidisciplinary team.
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Bajpai RR, Razdan S, Sanchez-Gonzalez MA, Razdan S. Simultaneous robotic assisted laparoscopic prostatectomy (RALP) and inguinal herniorrhaphy (IHR): proof-of-concept analysis from a high-volume center. Hernia 2019; 24:107-113. [PMID: 30877570 DOI: 10.1007/s10029-019-01926-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Inguinal hernia (IH) is detected in approximately 33% of RALP's either pre or intraoperatively wherein all are repaired during RALP to circumvent future herniorrhaphy (Fukuta et al., Urology 68(2):267-271, 2006; Nielsen, Urology 66(5):1034-1037, 2005). Some debate this policy by quoting the potential risk of mesh lying close to the vesicourethral anastomosis leading to infections and adhesions. The current study was initiated to elucidate the feasibility and outcomes of simultaneous inguinal herniorrhaphy (IHR) during RALP. METHODS Historic analysis of prospectively maintained data of 1224 RALP patients, as per inclusion criteria, between 2012 and 2017 was done, among whom 143 patients had a concurrent IHR using 3DmaxTM polypropylene monofilament mesh. Patients were then compared for demographics, peri-operative features, and outcomes. RESULTS The mean age and AUA score were significantly different (p < 0.002, p < 0.01 respectively) between patients undergoing only RALP and RALP with IHR. BMI was not significantly different. One hundred forty-three patients (11.6%) underwent IHR at 155 hernial sites, 12 sites being bilateral. One hundred and one sites (65.2%) were diagnosed intraoperatively. The mean console time was 67.4 ± 11.5 min for RALP which increased by 6.9 ± 10.7 min in unilateral and by 10.7 ± 8.6 min in bilateral IHR. There were no mesh-associated or Clavien Dindo class II-V complications. Mean follow-up was 36 ± 1.4 months with no recurrences. CONCLUSION This study reiterates the feasibility and advisability of repairing most inguinal hernias encountered during RALP as it is without any significant alteration of peri-operative morbidity, is associated with excellent post-operative outcomes, and obviates the need for a future surgical procedure.
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Affiliation(s)
- R R Bajpai
- Larkin University Hospital, South Miami, FL, USA
| | - S Razdan
- Urology, Icahn School of Medicine, Mount Sinai Hospital, New York, USA
| | - M A Sanchez-Gonzalez
- Division of Clinical and Translational Research, Larkin Community Hospital, South Miami, FL, USA
| | - S Razdan
- Director Endourology and Robotic Fellowship Program, International Robotic Prostatectomy Institute, Larkin University Hospital, Pavilion, 3650 N W 82nd Avenue, Suite 501, Doral, FL, 33166, USA.
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Ou YC, Wang SC, Yang CK, Cheng CL. Management of postoperative ileus after robot-assisted radical prostatectomy. FORMOSAN JOURNAL OF SURGERY 2019. [DOI: 10.4103/fjs.fjs_95_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Xia L, Taylor BL, Patel NA, Chelluri RR, Raman JD, Scherr DS, Guzzo TJ. Concurrent Inguinal Hernia Repair in Patients Undergoing Minimally Invasive Radical Prostatectomy: A National Surgical Quality Improvement Program Study. J Endourol 2018; 32:665-670. [PMID: 29717658 DOI: 10.1089/end.2018.0210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To compare perioperative 30-day outcomes between minimally invasive radical prostatectomy (MIRP) with and without concurrent inguinal hernia repair (IHR) using a national database. METHODS The National Surgical Quality Improvement Program database was queried for MIRP from 2012 to 2015. Concurrent IHR was identified using relevant Current Procedural Terminology codes. Primary outcomes were overall complications, reoperations, unplanned readmissions, and mortality within 30 days of MIRP. Secondary outcomes included operative time (OT), length of stay (LOS), prolonged length of stay (PLOS, >2 days), and discharged to continued care (DCC). Multivariable logistic regression was performed to identify the association between concurrent IHR and outcomes. RESULTS A total of 18,065 patients were included; 375 (2.1%) had concurrent IHR. The unadjusted comparison showed no significant difference in overall complication, reoperation, unplanned readmission, or mortality rates between MIRP+IHR and MIRP only groups. OT was longer in the MIRP+IHR group (229 vs 195 minutes, p < 0.001) but no differences were found in LOS, PLOS, or DCC rates. Multivariable logistic regression showed concurrent IHR was not associated with increased odds of overall complication (odds ratio [OR] = 0.83, 95% confidence interval [CI] = 0.49-1.40, p = 0.479), reoperation (OR = 0.57, 95% CI = 0.14-2.30, p = 0.426), unplanned readmission (OR = 0.92, 95% CI = 0.51-1.64, p = 0.771), PLOS (OR = 1.19, 95% CI = 0.86-1.63, p = 0.297), or DCC (OR = 1.94, 95% CI = 0.70-5.34, p = 0.202). CONCLUSIONS Concurrent IHR with MIRP was associated with longer OT, but there were no increased 30-day adverse outcomes within the National Surgical Quality Improvement Program (NSQIP) database. These data support the safety of performing concurrent IHR at the time of MIRP and it should be considered to spare men an additional procedure.
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Affiliation(s)
- Leilei Xia
- 1 Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania
| | - Benjamin L Taylor
- 2 Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital , New York, New York
| | - Neal A Patel
- 2 Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital , New York, New York
| | - Raju R Chelluri
- 1 Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania
| | - Jay D Raman
- 3 Division of Urology, Department of Surgery, The Pennsylvania State University College of Medicine , Hershey, Pennsylvania
| | - Douglas S Scherr
- 2 Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital , New York, New York
| | - Thomas J Guzzo
- 1 Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania
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10
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Robotic radical prostatectomy with concomitant repair of inguinal hernia: is it safe? J Robot Surg 2017; 12:325-330. [DOI: 10.1007/s11701-017-0737-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
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Soto-Palou FG, Sánchez-Ortiz RF. Outcomes of Minimally Invasive Inguinal Hernia Repair at the Time of Robotic Radical Prostatectomy. Curr Urol Rep 2017; 18:43. [PMID: 28417428 DOI: 10.1007/s11934-017-0690-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abdominal straining associated with voiding dysfunction or constipation has traditionally been associated with the development of abdominal wall hernias. Thus, classic general surgery dictum recommends that any coexistent bladder outlet obstruction should be addressed by the urologist before patients undergo surgical repair of a hernia. While organ-confined prostate cancer is usually not associated with the development of lower urinary tract symptoms, a modest proportion of patients treated with radical prostatectomy may have coexisting benign prostatic hyperplasia with elevated symptom scores and hernias may be incidentally detected at the time of surgery. Furthermore, dissection of the space of Retzius during retropubic or minimally invasive prostatectomy may result exposure of abdominal wall defects which may have been present, but asymptomatic if plugged with preperitoneal fat. Herein we examine the literature regarding the incidence of postoperative inguinal hernias after prostatectomy, review potential risk factors which could aid in preoperative patient identification, and discuss the published experience regarding concurrent hernia repair at the time of open or minimally invasive radical prostatectomy.
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Affiliation(s)
- Francois G Soto-Palou
- Robotic Urology and Oncology Institute and the Division of Urology, Department of Surgery, University of Puerto Rico School of Medicine, Suite 306, 400 F.D. Roosevelt Avenue, San Juan, PR, 00918, USA
| | - Ricardo F Sánchez-Ortiz
- Robotic Urology and Oncology Institute and the Division of Urology, Department of Surgery, University of Puerto Rico School of Medicine, The University of Texas MD Anderson Cancer Center, Suite 306, 400 F.D. Roosevelt Avenue, San Juan, PR, 00918, USA.
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Arcerito M, Changchien E, Bernal O, Konkoly-Thege A, Moon J. Robotic Inguinal Hernia Repair: Technique and Early Experience. Am Surg 2016. [DOI: 10.1177/000313481608201035] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Laparoscopic inguinal hernia repair has been shown to have multiple advantages compared with open repair such as less postoperative pain and earlier resume of daily activities with a comparable recurrence rate. We speculate robotic inguinal hernia repair may yield equivalent benefits, while providing the surgeon added dexterity. One hundred consecutive robotic inguinal hernia repairs with mesh were performed with a mean age of 56 years (25–96). Fifty-six unilateral hernias and 22 bilateral hernias were repaired amongst 62 males and 16 females. Polypropylene mesh was used for reconstruction. All but, two patients were completed robotically. Mean operative time was 52 minutes per hernia repair (45–67). Five patients were admitted overnight based on their advanced age. Regular diet was resumed immediately. Postoperative pain was minimal and regular activity was achieved after an average of four days. One patient recurred after three months in our earlier experience and he was repaired robotically. Mean follow-up time was 12 months. These data, compared with laparoscopic approach, suggest similar recurrence rates and postoperative pain. We believe comparative studies with laparoscopic approach need to be performed to assess the role robotic surgery has in the treatment of inguinal hernia repair.
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Affiliation(s)
- Massimo Arcerito
- University of California Riverside, Riverside, California
- Department of Surgery, Mission Surgical Clinic, Riverside, California
| | - Eric Changchien
- University of California Riverside, Riverside, California
- Department of Surgery, Mission Surgical Clinic, Riverside, California
| | - Oscar Bernal
- Riverside Community Hospital, Riverside, California
| | | | - John Moon
- University of California Riverside, Riverside, California
- Department of Surgery, Mission Surgical Clinic, Riverside, California
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