Kawamura Y J, Sawada T, Sunami E, Saito Y, Watanabe T, Masaki T, Muto T
Department of Surgical Oncology, School of Medicine, University of Tokyo, Japan.
Am J Surg. 1999 Jun;177(6):515-7. doi: 10.1016/s0002-9610(99)00095-1.
Laparoscopic technique has been applied to a variety of colonic and rectal operations, generally using carbon dioxide insufflation (CDI). However, CDI is inevitably associated with cardiopulmonary loading and can cause complications. The objective of this study was to determine the feasibility of gasless laparoscopic colonic surgery.
The abdominal wall was lifted up using an originally designed retractor. A small incision, 3 to 5 cm in length, was made at the start of the operation. The surgeon operated through this incision using both conventional and laparoscopic instruments.
Operations were undertaken in 67 patients. In 6 patients (9%), conversion to open surgery was necessitated. In the remaining 61 patients, operations were completed with gasless laparoscopically assisted technique. Four reoperations (7%) were performed because of postoperative bleeding, anastomotic rotation, anastomotic stricture, and transmesenteric hernia. Fifty-three patients with colonic cancer were operated on with potentially curative intent. Of these, 1 (2%) developed hepatic recurrence during the mean follow-up period of 23.8 months. There was no port site recurrence.
Gasless laparoscopic colonic surgery is technically feasible. CDI is not necessary to perform minimal access surgery.
腹腔镜技术已应用于各种结肠和直肠手术，通常采用二氧化碳气腹（CDI）。然而，CDI不可避免地会带来心肺负担并可能引发并发症。本研究的目的是确定无气腹腹腔镜结肠手术的可行性。
使用一种原创设计的牵开器将腹壁提起。在手术开始时做一个3至5厘米长的小切口。外科医生通过这个切口使用传统器械和腹腔镜器械进行手术。
对67例患者进行了手术。其中6例（9%）需要转为开腹手术。其余61例患者采用无气腹腹腔镜辅助技术完成手术。4例（7%）因术后出血、吻合口扭转、吻合口狭窄和肠系膜疝进行了再次手术。53例结肠癌患者接受了具有潜在治愈意图的手术。其中，1例（2%）在平均23.8个月的随访期内出现肝转移复发。未出现穿刺孔部位复发。
无气腹腹腔镜结肠手术在技术上是可行的。进行微创外科手术无需CDI。
