{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T12:14:44Z","timestamp":1778328884170,"version":"3.51.4"},"reference-count":25,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2024,8,9]],"date-time":"2024-08-09T00:00:00Z","timestamp":1723161600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Urology"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Inguinal hernia (IH) is a common postoperative complication after robot\u2010assisted radical prostatectomy (RARP). We developed a novel clipping technique for the prevention of IH developing after RARP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This cohort included 759 consecutive patients who underwent RARP for prostate cancer at the University of Tokyo Hospital between January 2011 and December 2018. We reviewed clinical parameters and identified the risk factors of postoperative IH. The prophylactic preventive procedure of IH development was performed by clipping the peritoneum and underlying tissue around the internal inguinal ring using Hem\u2010o\u2010Lok clip to prevent the prolapse of the intestine through the internal inguinal ring.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 236 patients received the clipping procedure. The median follow\u2010up time was 50\u2009months. The incidence rate of IH was 10.8% (78\/720). The median time to the diagnosis of IH was 10\u2009months. Univariate analysis revealed that patients with higher age (age\u2009\u2265\u200963), low BMI (BMI\u2009&lt;\u200925\u2009kg\/m<jats:sup>2<\/jats:sup>), and lower number of surgical experiences (Surgical experience\u2009&lt;\u200940) showed a significantly higher odds ratio of developing IH. Multivariate analysis showed that \u201cBMI\u2009&lt;\u200925\u2009kg\/m<jats:sup>2<\/jats:sup>\u201d and \u201cSurgical experience\u2009&lt;\u200940\u201d were independent predictive factors of IH. Among the patients with a high risk of IH due to receiving surgery from inexperienced surgeons, there was a statistically significant preventive effect for the patients with \u201cBMI\u2009\u2265\u200925\u2009kg\/m<jats:sup>2<\/jats:sup>\u201d by the novel clipping procedure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The novel clipping procedure reduced the risk of post\u2010operative IH in obese patients when the RARP was performed by inexperienced surgeons.<\/jats:p><\/jats:sec>","DOI":"10.1111\/iju.15544","type":"journal-article","created":{"date-parts":[[2024,8,9]],"date-time":"2024-08-09T13:02:09Z","timestamp":1723208529000},"page":"1241-1247","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Novel clipping procedure for preventing post\u2010operative inguinal hernia in robot\u2010assisted radical 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