Early Trocar Site Hernia Following Robotic-Assisted Roux-en-Y Gastric Bypass Involving the Novel da Vinci 5 8-mm Hexagonal High-Flow Configuration Trocar

Trocar site hernia (TSH) is a rare and typically morbid complication of minimally invasive surgery, with limited data regarding its incidence in contemporary robotic platforms. We report a case of early TSH following robotic-assisted laparoscopic Roux-en-Y gastric bypass (RYGB) with the novel da Vinci 5 system. A 48-year-old woman with obesity underwent RYGB utilizing an 8-mm hexagonal high-flow configuration (HHFC) trocar in the left abdomen. On post-operative day two, she developed emesis and epigastric pain. Cross-sectional imaging demonstrated small bowel dilation with a transition point at the left 8-mm trocar site, consistent with trocar site hernia causing small bowel obstruction. Urgent diagnostic laparoscopy confirmed herniation of small bowel through the fascial defect. Reduction and primary fascial closure were performed. The patient recovered appropriately. This case highlights the potential for clinically significant TSH at 8-mm HHFC trocar sites in high-risk settings and supports consideration of selective fascial closure in such patients.