Multiple Trocar-Site Hernias Following Robot-Assisted Incisional Hernia Repair: A Case Report
Abstract
Trocar-site hernia (TSH) is a recognized complication of minimally invasive surgery. Current guidelines suggest fascial closure for trocar sites of 10 mm or larger. However, there is limited evidence regarding the necessity of fascial closure for 8-mm trocar sites. The occurrence of multiple TSHs in a single patient following robot-assisted surgery has not been well documented. We present a rare case of three simultaneous TSHs at 8-mm robotic port sites following a robot-assisted incisional hernia repair. A 69-year-old male with a BMI of 28.8 kg/m2 presented with a symptomatic umbilical trocar-site incisional hernia following prior laparoscopic inguinal hernia repair, with an associated 3-4 cm diastasis recti. He underwent a robot-assisted incisional hernia repair using the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) via a ventral transabdominal preperitoneal approach with mesh reinforcement. Three 8-mm robotic trocars were used in the left lateral position, and fascial closure of these trocar sites was not performed. At two-week follow-up, the patient reported a new lump at the left inferior trocar site. Computed tomography confirmed a TSH containing fat in this location, which was subsequently confirmed intraoperatively to be omentum. Thirty-two days after the index operation, the patient underwent robot-assisted incisional hernia repair of this new hernia. At the time of the operation, three separate TSHs were identified at all three prior 8-mm port…
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