Comparing incisional hernia risk between single-port and multiport robot-assisted partial nephrectomy. A retrospective analysis

: Incisional hernia (IH) is a postoperative complication. No studies have investigated IH rates after Single Port (SP) partial nephrectomy (RAPN). This study aims to evaluate IH incidence after SP RAPN and to compare factors influencing IH in SP versus Multiport (MP) RAPN. Patients undergoing MP and SP RAPN were retrospectively included. Patients with less than 6 months follow-up, those undergoing concomitant procedures, converted to open or radical nephrectomy or with prior IH, were excluded from the study. A total of 279 patients (MP: 158(56.6%); SP: 121(43.4%)) were collected. IH developed in 12 patients (MP: 7 (4.4%); SP: 5 (4.1%)). In MP group, IH cases were more frequently associated with previous abdominal surgery (6 (85.7) vs. 22 (14.6); p < 0.001), higher BMI (36.4 (12.6) vs. 30.4 (9.25); p = 0.048) and presented with larger tumor size (4.0 (0.9) vs. 3.1 (1.6); p = 0.007). MP IH patients had larger tumors than those in SP group (4.0(0.9) vs. 2.8(0.4); p = 0.006). Stratified multivariable logistic regression demonstrated that previous abdominal surgery remained significantly associated with IH in the MP group (Odds ratio: 2.36; 95%CI: 1.06, 3.66; p < 0.001), while BMI was independently associated with IH only in MP RAPN (Odds ratio: 1.18; 95% CI: 1.02, 1.49; p = 0.028). IH rates after SP RAPN were comparable to those observed after MP RAPN. Established risk factors appeared to have a stronger impact in MP RAPN, while a lower observed incidence of IH was noted in selected SP subgroups, including those undergoing a retroperitoneal approach.