Evaluate the incidence and risk for postoperative incisional complications after robotic (rSILS) and traditional single incision laparoscopic surgery (SILS) for benign gynecologic conditions using various umbilical closure techniques.

Design:

Retrospective Cohort Study

Setting:

Academic institution, one surgeon at two hospitals.

Patients or Participants:

Women who underwent rSILS and SILS, 18-80 years old from November 2014 – June 2022.

Interventions:

Patient information including demographics, surgery, closure technique and postoperative incisional issues was collected. Univariate and multivariate analysis were used to predict postoperative incisional issues.

Measurements and Main Results:

Data from 1036 subjects was collected. Rates of hernia (primary outcome) and incision issues (secondary outcome) such as separation or infection were analyzed by closure technique. Hernia rate is lower when incision apices are tagged regardless of suture type compared to when apices are not tagged. (<.001) In the nontagged apices group there were 9 hernias in 209 patients. In the tagged apices groups, hernias occurred in 1 of 476 (permanent) 1 of 258 (absorbable) and 0 of 93 patients (permanent/absorbable combination). Rate of cellulitis or abscess were NOT significantly different amongst the groups, although wound separation was higher in closure with tagged apices with absorbable suture (3.1%) and a combination of permanent and absorbable suture (4.3%) compared to tagging with permanent suture (0.8%) or not tagging apices at all (1.9%). In multivariate analysis hernia rate was still notably decreased in closure groups with tagged apices at the start of surgery, although other incision complications did not vary.

Conclusion:

The incidence of incisional hernia after SILS and rSILS procedures is low however does vary with different techniques. Use of the closure technique with tagged apices regardless of suture type can mitigate one of the biggest concerns of performing single incision laparoscopic surgery and offer patients improved cosmesis compared to multiport laparoscopic or robotic surgery.