title: Transverse versus vertical camera port incision in robotic radical prostatectomy: effect on incisional hernias and cosmesis.
abstract: OBJECTIVE
  To examine the incidence of incisional hernias (IHs) and propose a simple modification to reduce the incidence of IHs. Robot-assisted radical prostatectomy (RARP) historically uses a vertical midline camera port incision to extract the prostate.
  
  
  METHODS
  Of 900 consecutive RARPs, the initial 735 had a vertical and subsequent 165 transverse incisions. Two methods were used to identify IHs: clinic visits noted in the prospective database and screening using electronic mail. We compared the baseline factors between the vertical IH and IH-free cohorts. The maximal scar width was recorded in 178 consecutive men presenting to our clinic: vertical (n=107) and transverse (n=71).
  
  
  RESULTS
  IHs occurred significantly more often after a vertical incision (5.3% vs 0.6%, P=.005). The IH rates after a vertical incision could be estimated to be as great as 16.7% (18 of 108) using the electronic mail respondents or as low as 3.3% (21 of 627) according to clinic follow-up. On univariate analysis, baseline age, International Index of Erectile Function 5-item questionnaire, prostate weight, bother score (all P≤.05), and body mass index (P=.058) were associated with an increased risk of an IH. After adjusting for baseline factors on multivariate logistic regression analysis, the relative odds of developing an IH with a vertical versus transverse incision was 11 (95% confidence interval 1.5-82). The average maximal scar width was reduced from 5.5 to 2.0 mm (P<.0001).
  
  
  CONCLUSIONS
  In the present sample population, the vertical IH rate was estimated to be potentially as low as 3.3% or as great as 16.7%. On multivariate analysis, a greater body mass index and larger prostate size significantly increased the risk of hernia development. Transverse incisions dramatically reduced the rate of IHs and the maximal scar width. The IH rates varied significantly by reporting method.
authors: Department of Urology, University of California, Irvine, School of Medicine, Orange, California 92868, USA.
authors: Shawn
authors: S
authors: Beck
authors: Douglas
authors: D
authors: Skarecky
authors: Kathy
authors: K
authors: Osann
authors: Reina
authors: R
authors: Juarez
authors: Thomas E
authors: TE
authors: Ahlering
mesh_terms: D002921:Cicatrix / Q000209:etiology; D046449:Hernia, Abdominal / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D012371:Robotics / Q000379:methods*