Comparing Incisional Hernia Risk Between Single-Port and Multiport Robot-Assisted Partial Nephrectomy: A Retrospective Analysis

Introduction: 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. Materials and Methods 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. Results 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 was 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 = 0048) and higher 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 with interaction terms between robotic technique and various clinical factors showed significant correlation with previous abdominal surgery in MP (Odds ratio: 2.36; 95%CI: 1.06, 3.66; p < 0.001) and SP (Odds ratio:0.11; 95%CI: 0.01, 0.25; p = 0.003) groups. BMI was significantly correlated with IH only in MP group (Odds ratio: 1.18; 95% CI: 1.02, 1.49; p = 0.028). Conclusion IH incidence after SP RAPN is comparable to MP RARP. Previous abdominal surgery increases IH risk in MP RAPN, while SP may be protective, particularly in patients with high BMI and larger tumors, especially when performed via a retroperitoneal approach.