While trocar site hernias are relatively rare following laparoscopic surgery, their morbidity can be significant. The relatively narrow aperture of these hernias can result in incarceration requiring an emergent operation and can lead to a bowel resection in rare circumstances. The incidence of overall trocar site hernia varies in the literature from 0 to 5.2% [1], with a recent systematic review showing a pooled incidence of 0.5% [2]. This review found that 82% of trocar site hernias occur at the umbilical port site and 96% of all port site hernias are associated with 10/12 mm trocar sites.

The data on trocar site hernia following robotic prostatectomy in the urology literature is even more limited with the two largest cohorts demonstrating incidences of 0.4% and 0.7% (2/498 and 7/1055), respectively [3, 4]. In these series, similar to the general trocar site literature, the majority of the hernias occurred at 12 mm sites. In the first series, both hernias occurred at the 12 mm umbilical trocar site [3], and in the second 6 of 7 hernias were at the 12 mm right lower quadrant port [4]. The findings in the second series likely reflect the increased use of larger right-sided trocar sites for the assistant’s port so that sutures can be passed into the abdomen and handed to the robotic arms.

There have been rare reports of trocar site hernias containing the appendix (Table 1) [5–7]; however to our knowledge this is the first report of an appendix-containing trocar site hernia following robot-assisted laparoscopic prostatectomy. Helgstrand and colleagues reported a trend towards decreased incidence of hernia formation with fascial closure (0.6%) versus no fascial closure (1.5%). Additionally, they also found that increased trocar size was strongly associated with an increased rate of hernia formation [1]. Further, Azurin and colleagues performed a retrospective review of 1300 patients undergoing laparoscopic cholecystectomy and found a rate of trocar site hernia of 0.77%, with all occurring at the 10 mm trocar site [8]. In addition, Erdas and colleagues found that 4.1% of 313 patients following laparoscopic cholecystectomy developed trocar site hernias over a mean follow-up period of 89.8 months [9]. 84.6% of these hernias occurred at the umbilicus while the remainder occurred at the 10 mm subxiphoid port. No trocar site hernias occurred at 5 mm ports or at 10 mm ports that were placed away from the midline.