Safety and utility of the modified Pfannenstiel incision in laparoscopic and robot-assisted colorectal surgery.

PURPOSE: We modified the Pfannenstiel (PS) incision by relocating it to the left lower abdomen, to combine the advantages of the PS incision with those of intracorporeal anastomosis in colorectal cancer surgery. We conducted this study to evaluate the safety and utility of our modified Pfannenstiel incision (mPS) incision in laparoscopic and robotic surgery.

METHODS

We reviewed, retrospectively, 357 colorectal cancer patients who underwent laparoscopic and robotic surgery between 2022 and 2025. The patients were divided into two groups based on the surgical incision used: those with the mPS incision (mPS group, n = 92) and those with a median incision (MED group, n = 265). After propensity score matching, 71 patients were matched in each group, and their clinicopathological and surgical features were compared.

RESULTS

After matching, the rates of robotic surgery (90.0% vs. 40.0%, p < 0.001) and intracorporeal anastomosis were higher (61.1% vs. 25.6%, p < 0.001), while the rates of wound infection (1.1% vs. 8.9%, p = 0.034) and incisional hernia were lower (2.2% vs. 22.2%, p < 0.001) in the mPS group than in the MED group.

CONCLUSIONS

The mPS incision resulted in favorable outcomes, comparable to those previously reported for conventional PS. Thus, the mPS is considered a useful incision method for intracorporeal anastomosis in robotic surgery.