Cuesta Miguel A, Berends Frits, Veenhof Alexander A F A
Department of Surgery, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands.
Surg Endosc. 2008 May;22(5):1211-3. doi: 10.1007/s00464-007-9588-y. Epub 2007 Oct 18.
Looking to further reduce the operative trauma of laparoscopic cholecystectomy, we developed, in patients with no history of cholecystitis and a normal BMI, a scarless operation through the umbilicus. The operative technique, along with the results of the first 10 patients operated in this way, are fully described.
10 female patients underwent transumbilical scarless laparoscopic cholecystectomy. Through the umbilicus, two trocars of 5 mm were introduced parallel to another with a bridge of fascia between them (one for the 5-mm laparoscope and the other for the grasper). With the help of one 1-mm Kirschner wire, introduced at the subcostal line and bent with a special designed device, the gallbladder was pulled up and the triangle of Callot was dissected free, clipped, cut, and the gallbladder was subsequently resected. Finally the gallbladder was taken out through the umbilicus and the umbilicus reconstructed.
10 female patients, mean age 36 years (range: 31-49), mean body mass index (BMI) 23 (range: 20-26), after one attack (six patients) or a second attack (four patients) and cholelithiasis confirmed by ultrasonography with no suspicion of inflammation were included in this preliminary study. Mean operative time was 70 minutes (range: 65-85) with no conversions; hospital stay was less than 24 hours with no complications.
Looking to reduce operative trauma and improve the cosmetic result following laparoscopic cholecystectomy, a transumbilical operative technique has been developed. Results of the operative procedure in a selected group of patients are encouraging with no signs of inflammation and normal BMI. The umbilicus can be developed as a natural port for performing various operative procedures with the help of the traction produced by thin Kirschner wires.
为进一步减少腹腔镜胆囊切除术的手术创伤，我们针对无胆囊炎病史且体重指数正常的患者，开发了一种经脐无痕手术方法。本文将全面描述该手术技术以及首批采用此方法进行手术的10例患者的手术结果。
10例女性患者接受了经脐无痕腹腔镜胆囊切除术。经脐部平行置入两根5毫米的套管针，其间保留一条筋膜桥（一根用于置入5毫米腹腔镜，另一根用于置入抓钳）。在肋下线处置入一根1毫米的克氏针，并借助一种特殊设计的装置使其弯曲，将胆囊提起，游离并夹闭、切断胆囊三角，随后切除胆囊。最后，将胆囊经脐部取出并重建脐部。
10例女性患者，平均年龄36岁（范围：31 - 49岁），平均体重指数（BMI）为23（范围：20 - 26）。这些患者均因超声检查确诊为胆石症，且无炎症可疑迹象，其中6例为首次发作，4例为第二次发作。本初步研究纳入了这些患者。平均手术时间为70分钟（范围：65 - 85分钟），无一例中转开腹；住院时间少于24小时，无并发症发生。
为减少腹腔镜胆囊切除术后的手术创伤并改善美容效果，我们开发了一种经脐手术技术。在选定的一组患者中，手术结果令人鼓舞，未出现炎症迹象且体重指数正常。借助细克氏针产生的牵引力，脐部可作为进行各种手术操作的天然通道。
