Robotic port-site hernias after general surgical procedures

J Surg Res. 2018 Oct;230:7-12. doi: 10.1016/j.jss.2018.04.032. Epub 2018 May 12.

Abstract

Background: With the increasing use of the robotic platform in general surgery, whether 8-mm ports should be closed comes into question. We sought to characterize the incidence of port-site hernias (PSHs) among patients undergoing robotic-assisted general surgery.

Methods: A retrospective chart review of a single institutional database identified patients who underwent robotic-assisted general surgery from July 2010 to December 2016. For each patient, the number, type, location, and size of all ports were collected. Twelve-millimeter port sites were routinely closed, whereas 5-mm and 8-mm port sites were not. PSH was detected on review of documented physical examination and of postoperative cross-sectional imaging, when available, in which case it was defined as a disruption of the fascia with or without eventration of tissue at a site of prior port placement.

Results: One hundred and seventy-eight patients underwent robotic-assisted general surgery, with 725 total ports: 433 8-mm working ports, 72 12-mm working ports, 178 12-mm camera ports, and 42 5-mm assistant ports. Ninety-four percent of the patients were men, the mean age was 63 ± 12, body mass index was 29 ± 7 kg/m2, and the median American Society of Anesthesiologists score was 3. Types of cases included 68 rectal (38.2%), 36 colon (20.2%), 25 hepatopancreatobiliary (14.0%), 21 inguinal hernia (11.8%), and 28 "other" (15.7%) operations. At a median follow-up of 193 d, there were three PSHs through 8-mm port sites (0.7%), two PSHs through 12-mm port sites (0.8%), and no PSH through 5-mm port sites. Two of the three 8-mm PSHs occurred in the early postoperative period and required emergent repair due to small bowel incarceration.

Conclusions: PSHs through 8-mm robotic port sites occur infrequently but can cause significant morbidity. Further investigation with longer follow-up is warranted to better understand the true incidence of robotic PSH.

Keywords: General surgery; Port-site hernia; Robotic surgery.

MeSH terms

  • Aged
  • Fascia / diagnostic imaging
  • Female
  • Hernia, Abdominal / diagnostic imaging
  • Hernia, Abdominal / epidemiology*
  • Hernia, Abdominal / etiology
  • Humans
  • Incidence
  • Laparoscopy / adverse effects*
  • Laparoscopy / methods
  • Male
  • Middle Aged
  • Postoperative Complications / diagnostic imaging
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Robotic Surgical Procedures / adverse effects*
  • Robotic Surgical Procedures / methods