title: Incidence of trocar site herniation following robotic gynecologic surgery.
abstract: OBJECTIVE
  Trocar site herniation is a recognized complication of minimally invasive surgery, but published data on trocar site herniation after robotic surgery are scarce. We sought to determine the incidence of trocar site herniation in women undergoing robotic surgery for gynecologic disease.
  
  
  METHODS
  A retrospective review of robotic surgeries performed from January 1, 2006, through December 31, 2012, was conducted. Postoperative trocar site herniations were identified, along with time to presentation, location of herniation, and management. Patients were excluded if surgery was converted to laparotomy or traditional laparoscopy. The Wilcoxon rank-sum test was used to compare patients with and without herniation with respect to continuous variables, and Fisher's exact test was used to compare these 2 groups with respect to categorical variables.
  
  
  RESULTS
  The study included 500 patients, 3 of whom experienced herniation at a single trocar site. The patients with and without herniation did not differ with respect to age, body mass index, smoking status, medical comorbidities, operating time, or estimated blood loss. All 3 herniations occurred at 12-mm trocar sites. Two herniations occurred at assistant port sites, and 1 occurred at the umbilical camera port site. The median time to herniation was 21 days (range, 8-38 days). One patient required immediate surgical intervention; the other 2 patients had conservative management.
  
  
  CONCLUSIONS
  Trocar site herniation is a rare complication following robotic surgery. The most important risk factor for trocar site herniation appears to be larger trocar size, as all herniations occurred at 12-mm port sites.
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, NC, USA.
authors.forename: Leslie H
authors.initials: LH
authors.lastname: Clark
authors.forename: Pamela T
authors.initials: PT
authors.lastname: Soliman
authors.forename: Diego
authors.initials: D
authors.lastname: Odetto
authors.forename: Mark F
authors.initials: MF
authors.lastname: Munsell
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Schmeler
authors.forename: Nicole
authors.initials: N
authors.lastname: Fleming
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Westin
authors.forename: Alpa M
authors.initials: AM
authors.lastname: Nick
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
mesh_terms: D000328:Adult; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D006547:Hernia / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D011677:Punctures; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods* / Q000706:statistics & numerical data; D013781:Texas / Q000453:epidemiology
keywords: Gynecologic surgery; Port site hernia; Robotic surgery; Trocar site hernia