Incisional Hernia Following Hand-Assisted Laparoscopic Surgery for Renal Cell Cancer

OBJECTIVES: For renal cell cancer, the hand-assisted laparoscopic approach provides several advantages while maintaining equal advantages with regards to patient recovery. We offer our experience with laparoscopic hand-assisted radical nephrectomy and the incidence of ventral wall hernia. METHODS: Between February 1999 and July 2002, we performed 50 laparoscopic hand-assisted radical nephrectomies. A midline or a muscle splitting right lower quadrant incision was used depending on the side of the tumor. Hand-port incisions were all between 7 cm and 8 cm and closed with #1 polydioxanone sulfate suture in a running fashion. Three (6%) patients developed hand-port incisional hernias. All hernias occurred in midline hand-port sites. The average body weight of those who developed an incisional hernia was 137 kg. Although the cause of incisional hernia is multifactorial, we believe that obesity plays a significant role. The technical limitations involved in closing a short, deep ventral incision combined with the earlier return to activity of laparoscopy patients put this patient population at significant risk. CONCLUSION: We now perform an interrupted closure with nonabsorbable suture for the hand-assist incision and limited activity for 4 weeks to 6 weeks post procedure in high-risk patients. We have had no further wound hernias since adopting these changes.