Incidence and Treatment of Incarcerated Trocar-Site Hernias After Robotic Surgery: Presentation of Three Cases

Abstract

Background: Trocar-site hernias (TSHs) are an uncommon but potentially severe complication of robot-assisted urologic surgery, with an incidence of incarcerated hernias varying from 0.4% to 0.66%. Currently, there are no standardized guidelines on trocar site fascial closure. Although it is widely recommended to close the midline 12-mm port site, there is no agreement on the need for fascial closure of lateral port sites, especially if ≤12 mm. Cases Presentation: We report three cases of incarcerated intestinal TSHs in the past 10 years in our institution. All were from lateral abdominal ports (two 12 and one 8 mm), after robot-assisted radical prostatectomy. Patients were Caucasian and from 60 to 71 years; symptoms varied widely from obstinate hiccups, abdominal distention with fever, to acute abdomen. In all cases reduction of the herniated loop from the outside, using a minilaparotomy over the port site, was safe and effective. However, in one case bowel resection for bowel ischemic necrosis was necessary. No specific clinical risk factors could be identified in our cases. Conclusion: Incarcerated TSH after robotic urologic surgery may arise from any trocar site, regardless of size and location. This could be treated effectively with a minilaparotomy over the trocar site, to avoid more serious life-threatening consequences such as bowel necrosis and perforation. No risk factor seems to be predictive of TSHs.

Keywords: minimally invasive surgery; robotic complications; robotic surgery; trocar-site hernia.

FIG. 1.

Abdominal CT images of the first case, showing an incarcerated bowel loop at the level of the right lateral 12-mm trocar port site. The bowel loop is visible in the axial (A) and coronal (B) views, indicated by the arrows.

FIG. 2.

The second case presented a left lateral inferior 8-mm port-site TSH, diagnosed with an abdominal CT scan (A): axial view, shown by the arrow. A minilaparotomy over the port site showed a herniated ischemic bowel loop (B). TSH, trocar-site hernia.

FIG. 3.

Abdominal CT images of the third case, showing an incarcerated bowel loop at the level of the right lateral 12-mm AirSeal^® trocar-site. The bowel loop is incarcerated inside the abdominal wall (A, axial view; B, coronal view), as shown by the arrows.