MP37-10 TROCAR SITE HERNIATION FOLLOWING ROBOTIC RENAL SURGERY IN AN OBESE POPULATION: A COMPARISON OF VICRYL FASCIA CLOSURE AND SURGICEL® PLUGS

摘要

You have accessJournal of UrologyTechnology & Instruments: Robotics - Benign & Malignant Disease1 Apr 2014MP37-10 TROCAR SITE HERNIATION FOLLOWING ROBOTIC RENAL SURGERY IN AN OBESE POPULATION: A COMPARISON OF VICRYL FASCIA CLOSURE AND SURGICEL® PLUGS Chad Hubsher, Can Talug, and Mohamad Salkini Chad HubsherChad Hubsher More articles by this author , Can TalugCan Talug More articles by this author , and Mohamad SalkiniMohamad Salkini More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1247AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Few reports address the optimal closure technique for trocar sites during robotic-assisted laparoscopic renal surgery. Nor do many reports differentiate based on a patient’s body mass index (BMI). In an attempt to identify the ideal technique for robotic port site closure in an obese population, we compared the presence of trocar site hernias on follow up imaging in patients whom fascia was closed with a Vicryl suture to those with placement of Surgicel® plugs following robotic renal surgery. METHODS A retrospective review of obese patients that underwent robotic-assisted laparoscopic radical and partial nephrectomies was performed. Attention was focused on technique of trocar site fascia closure and presence of port site hernias on follow-up CT imaging. RESULTS Between 2009 and 2012, 53 patients with BMI > 30 (mean 37.0, range 30.1 to 58.8) underwent robotic-assisted laparoscopic radical and partial nephrectomies with an average follow-up with CT imaging of 14.2 months (range 6 to 34 months). Robotic trocar sites of 8mm and 12mm were closed with Vicryl suture in 15 obese patients, with assistance of the Carter-Thomason CloseSure® System for fascial reapproximation in the 12mm ports. Follow up imaging indicated 1 small port site hernia. 38 obese patients underwent closure of port sites via placement of a Surgicel® Original Absorbable Hemostat plug at the level of the abdominal wall fascia under direct visualization, followed by Vicryl closure of the dermis. 1 small trocar site hernia was identified on follow up imaging in this group as well. There was no significant difference in BMI between the two groups (p = 0.47) and no difference in hernia formation based on CT imaging (p = 0.49). CONCLUSIONS In obese and morbidly obese patients undergoing robotic-assisted laparoscopic radical or partial nephrectomies, closure of the robotic trocar sites with Surgicel® plugs or Vicryl suture are both suitable techniques for hernia prevention. Here we propose a novel technique of utilizing a Surgicel® plug for closure of robotic port sites, which may decrease overall cost, operative time, and inadvertent bowel injuries caused by a closure device; although further investigation with a larger sample size may be warranted. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e395 Advertisement Copyright & Permissions© 2014Metrics Author Information Chad Hubsher More articles by this author Can Talug More articles by this author Mohamad Salkini More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...