R. Diez-Barroso1, C. H. Palacio1, J. A. Martinez1, A. Artinyan1, K. Makris1,2, D. S. Lee1,2, N. N. Massarweh1,2, C. Chai1,2, S. Awad1,2, H. S. Tran Cao1,2 1Baylor College Of Medicine,Houston, TX, USA 2Michael E. DeBakey Veterans Affairs Medical Center,Houston, TX, USA
Introduction:
Robotic surgery has evolved as a platform for various general and oncologic surgical procedures. With increasing use of this technology, whether 8-mm ports should be closed comes into question. We sought to characterize the incidence of port site hernias (PSH) and outcomes of patients who underwent general and oncologic robotic-assisted surgical procedures.
Methods:
A retrospective chart review of a single institutional database identified patients who underwent robotic-assisted general and oncologic surgeries from July 2010 to December 2016. For each patient, the number, location, and size of all robotic ports were collected. PSH was detected either clinically or radiographically, in which case it was defined as a disruption of the fascia with eventration of fat or bowel at a site of prior port placement on imaging.
Results:
178 patients underwent robotic general and oncologic surgical procedures, with 725 total ports, including 433 8-mm working ports, 72 12-mm working ports, 178 camera ports, and 42 assistant ports. 94% of the patients were male, the mean age was 63±12, BMI was 29±7 kg/m^2, and median ASA score was 3.
Types of cases included rectal (38.2%), colon (20.2%), hepatopancreatobiliary (14.0%), inguinal hernia (12.4%), and other hernias (14.6%). 8-mm robotic port sites were not closed, whereas all larger port sites were.
At a median follow-up – defined by date of most recent surgery clinic visit or most recent abdominal cross-sectional imaging study available – of 193 days, there were 3 PSH through 8-mm port sites (1.7% of patients and 0.7% of 8-mm port sites). 2 of the 3 required emergent reoperation for small bowel incarceration, and both were through lateral-most port sites, above the iliac crest. BMIs of these two patients were 33 and 34, and operative times for their index operation were 598 minutes and 366 minutes. The third 8-mm PSH contained fat and was through a port site at the linea semilunaris.
Conclusion:
PSH through 8-mm robotic ports occur infrequently, but can cause significant morbidity. Closure of 8-mm port sites might be considered at sites of relative fixation where abdominal wall layers have limited ability to slide over one another, and in the setting of long operative times, significant torque at the port site, and patient factors such as obesity.