Department of Surgery, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK.
Department of Radiology, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK.
J Robot Surg. 2024 Oct 24;18(1):380. doi: 10.1007/s11701-024-02126-y.
Midline incision for extra-corporeal anastomosis is common with traditional laparoscopic right hemicolectomy. Incisional hernias develop in up to 20% of these patients within a year adding considerable morbidity and healthcare costs. Robotic assisted surgery (RAS) improves technical ease of intra-corporeal anastomosis, preventing midline extraction but its benefit over laparoscopy remains debated. We aimed to determine if robotic assisted surgery and Pfannenstiel extraction decreased the rate of radiologically detected incisional hernias compared to standard laparoscopy with extra-corporeal anastomosis. The secondary outcomes aimed to evaluate incidence of port site hernias in 8 mm robotic ports for which routine closure is not followed. Our single centre retrospective cohort study included patients who had minimally invasive right hemicolectomy and had cross-sectional imaging at least 1-year later. Patient demographics, body mass index, history of smoking or previous surgery was recorded. At imaging, evidence of new extraction site or port site-site hernia, contents and clinical impact was noted. A total of 100 patients (50 robotic and 50 laparoscopic) were included. Baseline characteristics appeared equally distributed. 16% (8 patients) who had laparoscopic surgery developed midline extraction site hernias which was significantly higher to RAS group (0 patients). 3 patients developed hernias at the site of robotic ports and this was more commonly at the right iliac fossa port. RAS, by simplifying intra-corporeal anastomosis has potential to eliminate incisional hernias, particularly when Pfannenstiel extraction is used. The potential for 8 mm robotic ports to develop clinically significant hernias cannot be ignored and meticulous closure can prevent patient harm.
中线切口进行体外吻合在传统腹腔镜右半结肠切除术很常见。在这些患者中，多达 20%的患者在一年内会发生切口疝，这会增加相当大的发病率和医疗保健成本。机器人辅助手术（RAS）改善了体内吻合的技术难度，防止了中线提取，但它相对于腹腔镜的优势仍存在争议。我们旨在确定与标准腹腔镜体外吻合相比，机器人辅助手术和 Pfannenstiel 提取是否能降低放射学检测到的切口疝的发生率。次要结果旨在评估 8 毫米机器人端口的疝发生率，这些端口未常规关闭。我们的单中心回顾性队列研究纳入了接受微创右半结肠切除术并在至少 1 年后进行了横断面成像的患者。记录了患者的人口统计学特征、体重指数、吸烟史或既往手术史。在影像学检查时，注意到新的提取部位或端口部位疝、内容物和临床影响的证据。共纳入 100 例患者（50 例机器人手术，50 例腹腔镜手术）。基线特征似乎分布均匀。接受腹腔镜手术的患者中有 16%（8 例）发生中线提取部位疝，明显高于 RAS 组（0 例）。3 例患者在机器人端口部位发生疝，这在右髂窝端口更为常见。通过简化体内吻合，RAS 有可能消除切口疝，特别是当使用 Pfannenstiel 提取时。不能忽视 8 毫米机器人端口有发展为临床显著疝的可能性，仔细关闭可以防止患者受到伤害。
