Robotic Incisional Hernia Repair After Robotic-assisted Radical Prostatectomy (RARP): A 3-port Approach

Incisional Hernia: A Surgical Complication or Medical Disease?

Incisional hernia (IH) is a frequent complication following abdominal surgery. The development of IH could be more sophisticated than a simple anatomical failure of the abdominal wall. Reported IH incidence varies among studies. This review presented an overview of definitions, molecular basis, risk factors, incidence, clinical presentation, surgical techniques, postoperative care, cost, risk prediction tools, and proposed preventative measures. A literature search of PubMed was conducted to include high-quality studies on IH. The incidence of IH depends on the primary surgical pathology, incision site and extent, associated medical comorbidities, and risk factors. The review highlighted inherent and modifiable risk factors. The disorganisation of the extracellular matrix, defective fibroblast functions, and ratio variations of different collagen types are implicated in molecular mechanisms. Elective repair of IH alleviates symptoms, prevents complications, and improves the quality of life (QOL). Recent studies introduced risk prediction tools to implement preventative measures, including suture line reinforcement or prophylactic mesh application in high-risk groups. Elective repair improves QOL and prevents sinister outcomes associated with emergency IH repair. The watchful wait strategy should be reviewed, and options should be discussed thoroughly during patients' counselling. Risk stratification tools for predicting IH would help adopt prophylactic measures.

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

Introduction

We report two cases where robotic-assisted laparoscopic radical prostatectomy and inguinal hernia repair were performed simultaneously.

Case presentation

In case one, hernia repair was performed by implantation of 3D Max™ mesh and closure of the peritoneum. Total console time was 156 min, of which hernia repair took 21 min. In case two, hernia repair was performed using Ventralight™ ST mesh. Total console time was 181 min, of which hernia repair took 23 min. Pelvic lymph node dissection was performed in case two but not in case one. Both patients were discharged 7 days postoperatively without severe complications or mesh infection.

Conclusion

It may be possible to perform robotic-assisted laparoscopic radical prostatectomy and inguinal hernia repair simultaneously.