Podolsky Erica R, Rottman Steven J, Poblete Honesto, King Stephanie A, Curcillo Paul G
Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
J Laparoendosc Adv Surg Tech A. 2009 Apr;19(2):219-22. doi: 10.1089/lap.2008.0275.
We have seen substantial changes in minimally invasive surgery since its development in the early 1900s. Over the past 10 years, the addition of natural orifice transluminal endoscopic surgery and robotics has turned our attention to improved cosmesis and advancements in instrumentation. We have developed a new technique-single port access (SPA) surgery-and have applied it to the cholecystectomy. In this paper, we present and review the application of this access technique to the first 5 consecutive patients that underwent an SPA cholecystectomy. All 5 patients were female, with an average age of 45 years and an average weight of 172 pounds. Indications included biliary dyskinesia and symptomatic cholelithiasis. Average operative time was 121 minutes in these initial 5 cases. All but 1 patient was discharged in 24 hours. At 6 months, no umbilical hernias were observed. This new technique allows for a complete cholecystectomy to be performed entirely through the umbilicus without the need for additional retraction sites or transabdominal sutures. This procedure utilizes the same basic technique of the laparoscopic cholecystectomy already employed by general surgeons. Therefore, the SPA cholecystectomy can be readily learned and performed by many surgeons without the need for expensive or experimental equipment. Using a single portal of entry to the abdominal cavity, the umbilicus, cosmesis, and scar reduction is achieved.
自20世纪初微创外科发展以来，我们已经看到了实质性的变化。在过去10年中，自然腔道内镜手术和机器人技术的加入使我们将注意力转向了改善美观和器械的进步。我们开发了一种新技术——单孔入路（SPA）手术，并将其应用于胆囊切除术。在本文中，我们展示并回顾了这种入路技术在连续5例接受SPA胆囊切除术患者中的应用。所有5例患者均为女性，平均年龄45岁，平均体重172磅。适应症包括胆囊运动障碍和有症状的胆结石。在最初的5例病例中，平均手术时间为121分钟。除1例患者外，所有患者均在24小时内出院。在6个月时，未观察到脐疝。这种新技术允许完全通过脐部进行完整的胆囊切除术，而无需额外的牵拉部位或经腹缝合。该手术采用了普通外科医生已经使用的腹腔镜胆囊切除术的相同基本技术。因此，许多外科医生可以很容易地学习和实施SPA胆囊切除术，而无需昂贵或实验性设备。通过使用进入腹腔的单一入口——脐部，实现了美观和减少疤痕的效果。
