Comment to the letter: Prevention from port site metastasis

Abstract

We would like to thank Dr. Ali Kagan Coskun and Dr. Zuhal Yapici Coskun for their interest in our paper [1] and their useful comments [2].Our paper is the first systematic review analysing portsite metastases in patients with gynaecological cancers undergoing robotic operations. As noted by our colleagues, there is already enough and valuable knowledge in the field based on laparoscopic operations. Till now, the recurrence rates seem to be similar to laparoscopy [3]; however, as robotic is a rather new technique, we do not know yet if such recurrences are underreported or if such recurrences would be increased with the increased volume of robotic operations. On the other hand, better surgical training and raised awareness of such a complication might lead to minimizing such a rare finding. The main mechanisms which explain such a recurrence are similar to laparoscopy; however, according to Lönnerfors et al. [4] there are some extra mechanisms related to the robotic technique itself, including sliding of the patient and strong lateral movements of the robotic arms which lead to larger abdominal wall trauma and easier tumour cell implantation. Moreover, tumour manipulation seems to be one of the principal factors acting in cell spillage and so the force applied due to the lack of tactile sensation on the lymph nodes during dissection or retrieval may also lead to port metastases [4].The main aim of our paper is to raise the clinical suspicion in order to optimize the measures taken to prevent such a rare complication. Based on Freitas et al. paper [5], we agree that such measures should be divided into preoperative and technical, and as suggested by our group in a recent paper [6] these measures should take into account all the patient-related, tumour-related, wound-related and surgical technique-related parameters.Once again, we agree with our colleagues and we thank them for their valuable comments.Conflict of interest None.