Ateş Oğuz, Hakgüder Gülce, Olguner Mustafa, Akgür Feza M
Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey.
J Pediatr Surg. 2007 Jun;42(6):1071-4. doi: 10.1016/j.jpedsurg.2007.01.065.
BACKGROUND/PURPOSE: Laparoscopic appendectomy (LA) is becoming popular for the treatment of acute and perforated appendicitis. Since it was first described, LA has been modified various times. We present the results of a new technique of LA conducted through a single port without exteriorizing the appendix to perform the operation.
Single-port LA was attempted in 38 patients (23 boys, 15 girls). Under general anesthesia, an 11-mm port with two 5-mm working channels or an 11-mm port through which a 10-mm scope (0 degrees) with a parallel eyepiece and a 6-mm working channel was inserted through the umbilicus. The appendix was grasped and dissected from the surrounding tissues with a single dissector or grasper. With a percutaneously inserted suture from the right lower quadrant into the peritoneal cavity, the appendix was pulled toward the abdominal wall after passing the suture through the mesoappendix. After mesenteric dissection with hook cautery, the base of the appendix was ligated with 2-0 polyglactin with a fisherman knot. The appendix was withdrawn into the trocar and extracted from the abdomen together with the trocar.
Laparoscopic appendectomy was completed in 35 patients through a single port. A second port insertion was required in 3 patients. No peroperative and postoperative complications were encountered. Average duration of the procedure was 38 +/- 5.6 minutes.
This unique method further improves the minimal invasiveness of LA because a single port is used. Single-port intracorporeal appendectomy procedure is a safe, highly minimal invasive procedure with excellent cosmetic results.
背景/目的：腹腔镜阑尾切除术（LA）在急性和穿孔性阑尾炎的治疗中越来越受欢迎。自首次描述以来，LA已多次改进。我们展示了一种通过单孔进行LA的新技术的结果，该技术在不将阑尾外置的情况下进行手术。
对38例患者（23例男孩，15例女孩）尝试进行单孔LA。在全身麻醉下，经脐插入一个带有两个5毫米工作通道的11毫米端口或一个11毫米端口，通过该端口插入一个带有平行目镜的10毫米（0度）腹腔镜和一个6毫米工作通道。用单个解剖器或抓钳将阑尾从周围组织中分离并抓取。通过从右下腹经皮插入缝线至腹腔，将缝线穿过阑尾系膜后，将阑尾拉向腹壁。用钩形电刀进行肠系膜分离后，用2-0聚乙醇酸以渔夫结结扎阑尾根部。将阑尾撤回套管针并与套管针一起从腹部取出。
35例患者通过单孔完成了腹腔镜阑尾切除术。3例患者需要插入第二个端口。未遇到术中及术后并发症。手术平均持续时间为38±5.6分钟。
这种独特的方法进一步提高了LA的微创性，因为使用了单个端口。单孔体内阑尾切除手术是一种安全、高度微创的手术，具有极佳的美容效果。
