Incisional and port-site hernias following robotic colorectal surgery

Harr, Jeffrey N.; Juo, Yen Yi; Luka, Samuel; Agarwal, Savita; Brody, Fred; Obias, Vincent

doi:10.1007/s00464-015-4639-2

Cited by 49 publications

(38 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a study by Harr et al , they did not find any port site hernias in 259 patients undergoing colorectal robotic surgery 13. However, when port site hernias do occur, they can cause devastating outcomes, as we saw in our patients with obesity.…”

Section: Discussionsupporting

confidence: 43%

See 1 more Smart Citation

Port site hernias following robotic colorectal surgery in people with obesity

Chang

Morin

Liu³

et al. 2018

BMJ Case Reports

View full text Add to dashboard Cite

Port site hernias are a rare complication following robotic surgery that can result in disastrous outcomes. We describe incarcerated port site hernias in two patients with obesity. Both patients required laparoscopic reduction. Following laparoscopic reduction, one patient's postoperative course was complicated by pneumatosis intestinalis, requiring exploratory laparotomy and subsequent small bowel resection. It is standard practice to not close the fascia of port sites less than 12 mm in robotic surgery. However, this allows for the rare possibility of small bowel herniation through the port site. We suggest that our patients' history of obesity and metabolic dysfunction contributed to difficult port retention during the case, and longer operating times which caused an increased amount of torque at the port site. Additionally, compared with laparoscopic surgery, robotic surgery is associated with increased torque at port sites. The combination of these risk factors extended the fascial defect, ultimately leading to the incarceration of small bowel in the port site.

show abstract

Section: Discussionsupporting

confidence: 43%

“…To prevent port site hernias, Swank et al suggests closing the fascia at the port site 14. In the study by Harr et al , they closed the fascia of all ports >10 mm 13. They did not report any hernias in the 5 mm or 8 mm ports and therefore do not recommend that they be closed 13…”

Section: Discussionmentioning

confidence: 99%

Port site hernias following robotic colorectal surgery in people with obesity

Chang

Morin

Liu³

et al. 2018

BMJ Case Reports

View full text Add to dashboard Cite

show abstract

“…More pain would be expected from midline incisional specimen extraction sites when compared to incisions off-midline, and more pain from extracorporeal when compared to intracorporeal MIS techniques. 32,33 We could not determine if these differences impacted this study as specimen extraction site location and anastomosis technique data were not available in the PHD dataset. A Danish randomized trial comparing RS and LS approaches to rectal cancer showed that RS patients received less opioid during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Health care providers, public health consortiums, and regional and federal legislators have implemented strategies to limit opioid prescribing in situations that may increase opioids in the community after discharge. 6,32 Patients undergoing gastrointestinal surgery are at higher risk for prolonged postoperative use of opioids, 2,10 and for many patients, the perioperative period is often their first exposure to opioids. The risk for persistent opioid use therefore begins during and shortly after surgery, and this is the focus of our study.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive sigmoidectomy for diverticular disease decreases inpatient opioid use: Results of a propensity score-matched study

Bastawrous

Shih

et al. 2020

The American Journal of Surgery

View full text Add to dashboard Cite

a b s t r a c tBackground: Patients undergoing gastrointestinal surgery are at high risk for postoperative opioid use. Methods: We evaluated inpatient opioid use among patients undergoing sigmoidectomy for diverticular disease from the Premier Hospital Database and compared across surgical approaches using propensity score-matching analysis. Results: After the day of surgery, minimally invasive (MIS) patients were administered significantly lower doses of parenteral opioids (median daily morphine milligram equivalents [MME]: 33.3 versus 48.3, p < 0.001). Within MIS, significantly less parenteral opioids were used by the robotic-assisted (RS) than the laparoscopic (LS) group (median daily MME: 30.0 versus 36.8, p ¼ 0.012). MIS patients were more likely than open to start oral opioids on the day of surgery (MIS vs. OS: 8.7% vs. 6.6%, p < 0.001; RS vs. LS: 12.6% vs. 10.2%, p ¼ 0.048). Conclusion: Minimally invasive sigmoidectomy for diverticular disease was associated with less postoperative parenteral opioid use and starting oral opioids sooner after surgery compared to the open approach.

show abstract

“…IA may present some advantages, such as reducing the chance of twisting intestinal stumps and causing injuries by specimen traction. IA also allows choosing the location of the specimen extraction incision, reducing the possibility of incisional hernia [41,49,50] . IA application in LRC has been limited due to its technical difficulty [25,[51][52][53][54] , which may be mitigated by the use of [21] SIRC Umbilicus Trastulli et al [17] Si and Xi Blumberg [26] Si MtL 330 Y Y Y Cleary et al [27] Si and Xi…”

Section: Intra-corporeal Vs Eamentioning

confidence: 99%

Minimally invasive right colectomy - from conventional laparoscopic resection to robotic-assisted surgery: a narrative review

Moroni¹,

Payá‐Llorente²,

Lauka³

et al. 2019

MIS

View full text Add to dashboard Cite

Robotic-assisted abdominal surgery was introduced with the aim of overcoming the drawbacks of the conventional laparoscopic approach. The present narrative review focuses on the comparison between laparoscopic and roboticassisted approaches for right colectomy (RC) regarding short-and long-term outcomes, costs, and learning curve.The main technical aspects related to the use of robotic assistance for this specific procedure are further discussed.Minimally invasive RC is considered technically challenging due to the particularities of the right and middle colic vascular anatomy. Robotic RC is not yet widespread due to its high cost and longer operating time. However, its use may result in advantages regarding short-term clinical outcomes, and it facilitates the acquisition of basic surgical skills by speeding up the learning curve of minimally invasive colorectal surgery.

show abstract

Incisional and port-site hernias following robotic colorectal surgery

Abstract: Midline extraction sites are associated with a significantly increased rate of incisional hernias compared to muscle-splitting extraction sites. There is little evidence to recommend fascia closure of 8-mm trocar sites.

Cited by 49 publications

References 32 publications

Port site hernias following robotic colorectal surgery in people with obesity

Port site hernias following robotic colorectal surgery in people with obesity

Minimally invasive sigmoidectomy for diverticular disease decreases inpatient opioid use: Results of a propensity score-matched study

Minimally invasive right colectomy - from conventional laparoscopic resection to robotic-assisted surgery: a narrative review

Contact Info

Product

Resources

About