Incidence of port site hernias and/or dehiscence in robotic-assisted procedures in gynecologic oncology patients

Abstract

ObjectivesThe incidence of port site hernia and/or dehiscence using bladeless trocars is 0–1.2%. Robotic surgery uses additional port sites and increases manipulation of instruments, raising the concern for more complications. We sought to characterize the incidence of port site complications following robotic surgery when fascia was not routinely closed. MethodsRobotically-assisted (RA) procedures performed for suspected gynecologic malignancy between 1/2006 and 12/2011 were retrospectively reviewed. Bladeless 12mm and 8mm robotic trocars were used. Fascial closure was not routinely performed except after specimen removal through the port site. The decision to close the fascia remained at the discretion of the surgeon. ResultsData from 842 procedures were included. Mean patient age was 55.6years. Mean Body Mass Index was 33.6kg/m2. RA-total laparoscopic hysterectomy (TLH)±unilateral or bilateral salpingo-oophorectomy (BSO)±lymphadenectomy (LND) accounted for 91.6% of procedures. Final pathology confirmed malignancy in 58.6% of cases, primarily endometrial cancer. In 35 cases, the specimen was removed through the port site; fascia was closed in 54.3% of them and no port site hernias or dehiscences occurred. Only one patient underwent a RA-TLH/BSO/LND for endometrial adenocarcinoma and had a port site dehiscence of the 8mm trocar site. No port site hernias occurred. ConclusionPort site hernias and dehiscences are rare in RA gynecologic oncology procedures. When bladeless dilating trocars are used, routine closure of even up to a 12mm port site is unnecessary, even in cases requiring removal of the specimen through the trocar sites.