Incidence of trocar site herniation following robotic gynecologic surgery

Abstract

Objective Trocar site herniation is a recognized complication of minimally invasive surgery, but published data on trocar site herniation after robotic surgery are scarce. We sought to determine the incidence of trocar site herniation in women undergoing robotic surgery for gynecologic disease. Methods A retrospective review of robotic surgeries performed from January 1, 2006, through December 31, 2012, was conducted. Postoperative trocar site herniations were identified, along with time to presentation, location of herniation, and management. Patients were excluded if surgery was converted to laparotomy or traditional laparoscopy. The Wilcoxon rank-sum test was used to compare patients with and without herniation with respect to continuous variables, and Fisher's exact test was used to compare these 2 groups with respect to categorical variables. Results The study included 500 patients, 3 of whom experienced herniation at a single trocar site. The patients with and without herniation did not differ with respect to age, body mass index, smoking status, medical comorbidities, operating time, or estimated blood loss. All 3 herniations occurred at 12-mm trocar sites. Two herniations occurred at assistant port sites, and 1 occurred at the umbilical camera port site. The median time to herniation was 21 days (range, 8-38 days). One patient required immediate surgical intervention; the other 2 patients had conservative management. Conclusions Trocar site herniation is a rare complication following robotic surgery. The most important risk factor for trocar site herniation appears to be larger trocar size, as all herniations occurred at 12-mm port sites.

Trocar site hernia development in patients undergoing robotically assisted or standard laparoscopic staging surgery for endometrial cancer

“…Clark et al . described 3 cases of trocar site herniation among 500 patients (0.6%), with a median time to hernia formation of 21 days [8]. An analysis by Boone and colleagues showed no evidence of hernia formation in 842 study patients; however the follow-up time in their analysis was unclear [13].…”

“…Patients with these hernias often present with symptoms of a bowel obstruction and often require emergent reoperation. Late-onset hernias are commonly described as those that develop after 2 weeks following surgery; these hernias are often managed conservatively [8]. Several studies have explored trocar site hernia rates in either RBT surgery or LSC surgery, but none have compared the two approaches.…”

Port site hernias following robotic colorectal surgery in people with obesity

“…Clark et al encountered three port site hernias in 500 patients in the 12 mm ports they inserted 7. In their surgeries, they only routinely closed 12 mm ports and leave the fascia unclosed for 8 mm ports.…”

Herniation formation in women undergoing robotically assisted laparoscopy or laparotomy for endometrial cancer

“…In the gynecologic literature, only two studies evaluating the incidence of trocar site herniation in women who have undergone robotic-assisted laparoscopic surgery included 500 or more patients [13, 14]. In a 2013 study by Clark et al, 3 cases of trocar site herniation were noted among 500 patients, with a median time to hernia formation of 21 days (range, 8–38 days), and an overall median follow-up of 13 months [14]. A similar analysis by Boone and colleagues demonstrated no evidence of hernia formation in 842 study patients [13].…”

“…The incidence of trocar site hernias, although uncommon, has been shown to be a potential postoperative complication for patients who undergo robotic surgery [13, 14]. In sharp contrast, the reported incidence of ventral hernia formation in patients who underwent laparotomy for gynecologic malignancies ranges from 8.8% to 16.9% [15, 16].…”