Schiavone Maria B, Bielen Maciej S, Gardner Ginger J, Zivanovic Oliver, Jewell Elizabeth L, Sonoda Yukio, Barakat Richard R, Chi Dennis S, Abu-Rustum Nadeem R, Leitao Mario M
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
Gynecol Oncol. 2016 Mar;140(3):383-6. doi: 10.1016/j.ygyno.2016.01.010. Epub 2016 Jan 8.
To compare the incidence of trocar site hernia in women who underwent robotically assisted laparoscopic surgery (RBT) for endometrial cancer staging with the incidence of ventral hernia formation in patients who underwent laparotomy (LAP) for the same indication. To analyze risk factors for hernia formation in women undergoing RBT for endometrial cancer.
We retrospectively identified all patients who underwent surgical staging for endometrial cancer via RBT or LAP from 2009-2012. Clinicopathologic data were analyzed. Appropriate statistical tests were used.
738 patients were staged via RBT (n=567) or LAP (n=171). Overall median age was 61 years (RBT range, 33-90; LAP range,28-86; p=0.4). Median BMI was 29.5 kg/m(2) (range, 17.9-66) and 30.3 kg/m(2) (range, 16.8-67.2), respectively (p=1.0). Eleven (1.9%) of 567 patients in the RBT cohort developed a trocar site hernia compared with 11 (6.4%) of 171 LAP patients who developed a ventral hernia (p=0.002). Median time to diagnosis was 18 months (range, 3-49) and 17 months (range, 7-30), respectively (p=0.7). Of the 11 RBT patients who developed a trocar site hernia, 10 (91%) were midline defects and 1 (9%) was a lateral defect of a prior inferior epigastric port site. No hernias required emergent operative intervention. Four (0.7%) of 567 RBT patients compared with 2 (1.2%) of 171 LAP patients required surgical hernia repair (p=0.4).
Trocar site herniation after RBT staging for endometrial cancer is uncommon and less likely to occur than ventral hernia formation with LAP staging. Furthermore, surgical revision rates are low.
比较接受机器人辅助腹腔镜手术（RBT）进行子宫内膜癌分期的女性患者中套管针穿刺部位疝的发生率与因相同指征接受剖腹手术（LAP）的患者中腹疝形成的发生率。分析接受RBT进行子宫内膜癌手术的女性患者发生疝形成的危险因素。
我们回顾性确定了2009年至2012年期间所有通过RBT或LAP进行子宫内膜癌手术分期的患者。对临床病理数据进行分析，并使用了适当的统计检验。
738例患者通过RBT（n = 567）或LAP（n = 171）进行分期。总体中位年龄为61岁（RBT范围为33 - 90岁；LAP范围为28 - 86岁；p = 0.4）。中位体重指数分别为29.5 kg/m²（范围为17.9 - 66）和30.3 kg/m²（范围为16.8 - 67.2）（p = 1.0）。RBT队列中的567例患者中有11例（1.9%）发生了套管针穿刺部位疝，而LAP组的171例患者中有11例（6.4%）发生了腹疝（p = 0.002）。诊断的中位时间分别为18个月（范围为3 - 49个月）和17个月（范围为7 - 30个月）（p = 0.7）。在发生套管针穿刺部位疝的11例RBT患者中，10例（91%）为中线缺损，1例（9%）为先前下腹壁端口部位的外侧缺损。所有疝均无需紧急手术干预。567例RBT患者中有4例（0.7%）与171例LAP患者中有2例（1.2%）需要进行手术疝修补（p = 0.4）。
RBT分期子宫内膜癌后套管针穿刺部位疝并不常见，且比LAP分期发生腹疝的可能性小。此外手术翻修率较低。
