Inguinal Hernia Repair During Extraperitoneal Robot-Assisted Laparoscopic Radical Prostatectomy

One third of men undergoing radical prostatectomy have a comorbid inguinal hernia (IH). Previous studies have shown that adding total extraperitoneal (TEP) IH repair to extraperitoneal laparoscopic radical prostatectomy (LRP) lacks adverse effects. However, outcomes of extraperitoneal robot-assisted laparoscopic radical prostatectomy (RALP) and TEP are unknown. We compared RALP+TEP with LRP+TEP and also with RALP alone. Eleven RALP+TEP cases were retrospectively compared with 26 LRP+TEP cases and 22 control RALP without TEP. Outcomes compared between groups included operative time, estimated blood loss (EBL), discharge hematocrit (hct), time to diet advancement, length of hospital stay (LOS), postoperative complications, and hernia recurrence. Unilateral TEP added 32 minutes to RALP and 31 minutes to LRP, whereas bilateral TEP added 80 minutes to RALP and 36 minutes to LRP. There were no differences between RALP+TEP and LRP+TEP or RALP without TEP controls in regard to EBL, discharge hct, time to diet advancement, LOS, or postoperative complications. One patient developed an anterior mesh seroma, which resolved without intervention. No IH recurrences were noted on the mean follow-up of 33 months in the RALP group and 50 months in the LRP cohort. Unilateral and bilateral TEP added operative time to RALP but had equivalent outcomes to both LRP+TEP and RALP alone. This is likely due to the similar surgical space used for RALP and TEP, which obviates the need for substantial further dissection. For men with prostate cancer and comorbid IH, combined RALP+TEP appears to be an appropriate surgical combination.