Randomized trial of transverse vs vertical extraction site incision after robotic radical prostatectomy Journal Article


Authors: Gaffney, C. D.; Vertosick, E. A.; Laudone, V.; Goh, A. C.; Carlsson, S. V.; Pietzak, E.; Donahue, T.; Smith, R.; Touijer, K.; Vickers, A. J.; Ehdaie, B.
Article Title: Randomized trial of transverse vs vertical extraction site incision after robotic radical prostatectomy
Abstract: Purpose: Incisional hernias are a frequent complication following robotic radical prostatectomy. Observational data in men undergoing robotic prostatectomy suggest that transverse closure resulted in lower hernia rates than vertical closure. We sought to compare the incidence of incisional hernia after robotic radical prostatectomy after vertical and transverse extraction site closure. Materials and Methods: We conducted a clinically integrated, crossover, cluster randomized trial at a single tertiary referral center (January 2016-September 2021) comparing the rate of hernia after transverse vs vertical extraction site excision in 1356 patients treated with minimally invasive radical prostatectomy. The primary outcome was between-group incidence of incisional hernia within 15 months of prostatectomy defined by physical examination and self-reported patient surveys. Results: Overall, 197 (20%) patients developed an incisional hernia within 15 months, 797 did not have an incisional hernia within this period, and 362 had missing outcome data regarding incisional hernia. We found no significant difference in hernia rates between the 2 incision types (absolute between-group difference 1.8%; 95% CI -3.4%, 6.6%; P =.5) in the primary analysis or in the 3 sensitivity analyses. Notably, because of the inclusive definition of hernia used, these data cannot be used as an estimate of the true prevalence of incisional hernia. Conclusions: Surgeons should choose the incision and closure approach they are most comfortable with when extracting specimens. Studies of modifications to the surgical technique are best conducted as randomized comparisons, and the clinically integrated, crossover, cluster randomized trial allows large trials to be completed at a single center and at low cost. © 2024 by American Urological Association Education and Research, Inc.
Keywords: adult; controlled study; aged; middle aged; surgical technique; major clinical study; comparative study; outcome assessment; follow up; sensitivity analysis; randomized controlled trial; incidence; prevalence; postoperative complication; postoperative complications; prostatic neoplasms; health care quality; patient care; prostatectomy; prostate tumor; hernia; surgery; radical prostatectomy; physical examination; epidemiology; crossover procedure; hernioplasty; clinical examination; prevention and control; sample size; etiology; adverse event; cross-over studies; incisional hernia; incision; robotic prostatectomy; procedures; humans; human; male; article; tertiary care center; robotic surgical procedures; robot assisted surgery; robot-assisted prostatectomy; vertical; horizontal; incision site
Journal Title: Journal of Urology
Volume: 212
Issue: 3
ISSN: 0022-5347
Publisher: Elsevier Science, Inc.  
Date Published: 2024-09-01
Start Page: 401
End Page: 408
Language: English
DOI: 10.1097/ju.0000000000004066
PUBMED: 39115122
PROVIDER: scopus
PMCID: PMC11969568
DOI/URL:
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Behfar Ehdaie -- Source: Scopus
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MSK Authors
  1. Vincent Laudone
    138 Laudone
  2. Robert C Smith
    8 Smith
  3. Karim Abdelkrim Touijer
    259 Touijer
  4. Andrew J Vickers
    887 Vickers
  5. Behfar Ehdaie
    175 Ehdaie
  6. Sigrid Viktoria Carlsson
    221 Carlsson
  7. Timothy Francis Donahue
    72 Donahue
  8. Emily Vertosick
    136 Vertosick
  9. Eugene J Pietzak
    116 Pietzak
  10. Alvin Chun chin Goh
    74 Goh
  11. Christopher Daniel Gaffney
    15 Gaffney