This research article on robot-assisted radical prostatectomy with hernia repair, authored by Omaira Rodríguez González and colleagues, examines its safety and outcomes. Published in the Journal of Robotic Surgery in 2025, the study explores the feasibility of combining these procedures to optimize patient outcomes and reduce surgical risks. The motivation for this study stems from the high prevalence of both prostate cancer and inguinal hernias in elderly men, with estimates indicating that 20–33% of patients undergoing radical prostatectomy also present with an inguinal hernia, either preoperatively or incidentally during surgery.

Study Design and Methodology

The study employed a retrospective cohort design, analysing 40 patients who underwent simultaneous robot-assisted radical prostatectomy (RARP) and transabdominal preperitoneal (rTAPP) hernia repair from August 2021 to September 2024. The surgeries were performed at two medical centres using da Vinci Xi and Si robotic systems by a consistent surgical team comprised of a general surgeon and a urologist, ensuring uniformity in technique. The mean operative time recorded was 192.83 minutes, with the hernia repair taking an average of 54.2 minutes.

Outcomes and Complications

The results indicated no mesh-related complications, such as seromas or hematomas in the inguinal region. Minor complications (Clavien-Dindo classification ≤ 2) were observed in 25.64% of patients, including seromas (12.82%) and surgical site infections (7.69%). The average hospital stay was 1.9 days, and there were no hernia recurrences during a mean follow-up of 16.03 months. These findings underscore the safety and feasibility of performing RARP and rTAPP hernia repair concurrently, suggesting that this combined approach can minimize the need for additional surgeries and maintain low complication rates.

Discussion and Implications

The article discusses the advantages of simultaneous surgical intervention, which include reducing cumulative risks associated with separate procedures and optimizing healthcare resources. It emphasises that patients undergoing RARP are at risk for postoperative inguinal hernias, which can complicate future surgeries due to anatomical changes. By addressing both conditions at once, the study suggests that additional surgical challenges can be avoided.

The authors also highlight the importance of identifying asymptomatic hernias during preoperative evaluations, potentially preventing future complications. The data collected was thorough, ensuring a comprehensive assessment of preoperative, intraoperative, and postoperative variables.

Limitations and Future Directions

Despite the promising results, the study acknowledges limitations inherent to its retrospective design, including potential biases and a relatively small sample size, which may affect the generalisability of the findings. The authors recommend further multicentre studies and prospective designs to validate the results and assess long-term outcomes. Additionally, they propose implementing preoperative hernia screening protocols for patients scheduled for robotic prostatectomy to enhance patient management and reduce surgical interventions.

Conclusion

In conclusion, the combination of RARP with rTAPP hernia repair demonstrates a safe and efficient surgical strategy for managing concurrent prostate cancer and inguinal hernia in elderly men. This innovative approach not only minimises the risk of complications but also streamlines the surgical process, ultimately benefitting patient care. Further research is essential to solidify these findings and explore the long-term implications of this dual surgical intervention.

READ MORE… https://link.springer.com/article/10.1007/s11701-025-02233-4

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