Incidence of Port-Site Hernias After Robot-Assisted Radical Prostatectomy with the Fascial Closure of Only the Midline 12-mm Port Site

Abstract

BACKGROUND AND PURPOSE: Port-site hernias are rare complications that occur in approximately 1% of all laparoscopic surgeries. With the use of bladeless, blunt-tipped entry trocars, some surgeons have argued that not all port sites need fascial closure. Several cases of port-site hernia, however, have been reported recently with the use of bladeless trocars. This study evaluated the incidence of port-site hernias after robot-assisted radical prostatectomy (RARP) as we routinely closed the fascia of only the midline 12-mm port site. PATIENTS AND METHODS: From 2006 to 2009, 498 patients with localized prostate cancer underwent RARP. Bladeless dilating trocars were used in all of our patients. Routinely, six ports were used: two 12 mm, three 8 mm, and one 5 mm. Fascial closure was performed only for the midline supraumbilical 12-mm port site. RESULTS: In 498 cases of RARP, there were two port-site hernias (0.4%, 2/498). Both cases occurred at the midline supraumbilical 12-mm camera port site. No hernia developed at nonmidline port sites, including the lateral 12-mm port site. CONCLUSION: Trocar site hernias after RARP are rare. When bladeless dilating trocars are used, routine closure of fascia of non-midline 12-mm or smaller port sites is not necessary. Splitting the muscle and fascia without cutting likely renders routine closure of fascia unnecessary for nonmidline ports that are ≤ 12 mm.