2022-RA-1397-ESGO Covering all angles; a case report demonstrating why lateral port entry must be perpendicular

• Published in: International journal of gynecological cancer Vol. 32; no. Suppl 2; pp. A209 - A210
• Main Authors: Padden, Molly Grace, Elmezaien, Mohamed, Smotra, Grisham, El-Ghobashy, Alaa
• Format: Journal Article
• Language: English
• Published: Oxford BMJ Publishing Group Ltd 20.10.2022; BMJ Publishing Group LTD
• Subjects: Case reports; Endometrial cancer; Hernias; Hysterectomy; Miscellaneous; Request for proposal; Robotics
• DOI: 10.1136/ijgc-2022-ESGO.449
• ISSN: 1048-891X

Introduction/BackgroundOver 14 million minimal access surgeries (MAS) are performed globally each year, with its use continually rising. MAS are often preferred due to reduced length of hospital stay, reduced infection rates and minimal scarring. Although rare, postoperative port site bowel herniation can occur and has serious consequences. The Royal College of Obstetricians and Gynaecologists guidance recommends perpendicular port entry and rectus sheath closure for any non-midline port >7 mm.MethodologyThis is a report of a 77-year old lady who presented with intestinal obstruction following robotic hysterectomy for high grade endometrial cancer. The surgical notes, surgeons’ reflection and patient’s management were critically appraised and key notes were reviewed to prevent future similar complication.ResultsA patient underwent a robotic total hysterectomy and bilateral salpingoophorectomy for presumed stage 1B endometrial cancer. Day 5 post-discharge, she re-presented with abdominal pain, vomiting and constipation. Computerised tomography scan showed dilated bowel loops, in-keeping with bowel obstruction, due to an incarcerated left incisional hernia. She had an explorative laparoscopy, which identified a left iliac fossa port site hernia. The small bowel loops were reduced and showed no evidence of ischaemia. Interestingly, the port site measured 15 mm, despite a 7 mm incision being previously performed. The port site was closed using ‘Prolene’ suture. Postoperatively, the patient’s symptoms resolved and she was discharged. On reflection, the surgeon recalls using a bevelled entry technique to insert the port, which may have increased the diameter of the incision. Furthermore, the robotic arm movement may have increased torque at the port site and the rectus sheath was not sutured when closing despite the port site being >7 mm.ConclusionSurgeons must acknowledge the risk of lateral port site herniation, ensure lateral port site entry is always perpendicular and suture the rectus sheath if the opening is >7 mm.