Related Experiment Video
Updated: Mar 15, 2026
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Port site hernias following robot-assisted laparoscopic prostatectomy
Matthew Richard Hotston1,2, J D Beatty3, K Shendi3
1The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK. matthotston@hotmail.com.
Abstract:
Port site herniation is a rare but potentially major complication of laparoscopic surgery, but its importance within the context of robot-assisted laparoscopic prostatectomy (RALP) is less understood. We describe two cases that developed port site hernias following RALP, within a single surgeon case series of over 500 cases. Both patients re-presented with vague abdominal symptoms early following surgery, with a subsequent Computer tomography scan demonstrating small bowel herniation through the abdominal wall defect at the right lateral assistant 12 mm port site. Both required surgical exploration and successful repair. Following review of these cases and the current literature, we have since adapted our surgical approach. We recommend the routine use of a 'nonbladed' trocar for all 12 mm ports, which should also be formally closed incorporating all fascial layers. Early post-operative abdominal signs should alert the surgeon to its presence, and management should include immediate abdominal CT scanning and surgical re-exploration.
Insights
Robot-assisted laparoscopic prostatectomy (RALP) can lead to rare port site hernias. Implementing non-bladed trocars and formal fascial closure for 12 mm ports can prevent these complications.
Area of Science:
- Urology
- Surgical Complications
- Minimally Invasive Surgery
Background:
- Port site herniation is a known complication of laparoscopic surgery.
- Its incidence and significance following robot-assisted laparoscopic prostatectomy (RALP) are not well-established.
Purpose of the Study:
- To report cases of port site hernia after RALP.
- To recommend modifications in surgical technique to prevent this complication.
Main Methods:
- Case series of two patients who developed port site hernias post-RALP.
- Review of current literature on trocar use and port site closure in RALP.
- Modification of surgical technique based on case review.
Main Results:
- Two patients presented with early vague abdominal symptoms and diagnosed small bowel herniation through a 12 mm port site.
- Both patients required surgical exploration and repair.
- The authors adapted their technique to use non-bladed trocars and formal fascial closure for 12 mm ports.
Conclusions:
- Port site hernias are a potential complication of RALP.
- Routine use of non-bladed trocars and formal fascial closure for 12 mm ports are recommended.
- Early recognition of abdominal signs and prompt CT imaging are crucial for diagnosis and management.
