Teixeira J, McGill K, Binenbaum S, Forrester G
Department of Surgery, St. Luke's-Roosevelt Hospital Center, New York, NY, USA.
Surg Endosc. 2009 Jun;23(6):1409-14. doi: 10.1007/s00464-009-0411-9. Epub 2009 Mar 14.
Laparoendoscopic single-site (LESS) surgery for cholecystectomy and appendectomy are described in the literature. The benefits of these procedures compared with traditional laparoscopic approaches have yet to be determined. To date, no series of LESS surgeries for placement of an adjustable gastric band has been published or documented. This study aimed to determine the safety and feasibility of LESS surgery for placement of an adjustable gastric band.
From December 2007 to June 2008, LESS surgery to place an adjustable gastric band via a transumbilical incision was performed for 10 patients with institutional review board approval. Essentially, multiple ports were placed through a single incision in the umbilicus to allow for liver retraction, visualization, and working instruments. All critical steps using a standard pars flaccida technique were performed without alteration.
For this study, 10 patients (9 women and 1 man) were carefully selected. These patients ranged in age from 32 to 61 years (mean, 47 years) and had a mean body mass index (BMI) of 42 kg/m2 (range, 35-45 kg/m2). The patients were selected for absence of both hepatomegaly and central obesity. Superobese patients were not considered for inclusion in the study. The mean operative time was 1 h and 10 min (range, 53 min to 1 h and 48 min). All the patients were discharged home within 23 h of admission, and no perioperative complications were noted. In addition, no wound-related complications occurred. Notably, only 2 of the 10 patients required the use of narcotic analgesia after discharge from the recovery room. There were no intra- or postoperative complications.
In our experience, LESS surgery for adjustable gastric banding shows this technique to be both feasible and safe for selected patients. Although technical limitations exist that will be improved upon, further studies are needed to compare LESS surgery for placement of an adjustable gastric band with traditional laparoscopic techniques.
文献中描述了用于胆囊切除术和阑尾切除术的经自然腔道内镜手术（LESS）。与传统腹腔镜手术方法相比，这些手术的益处尚未确定。迄今为止，尚未发表或记录过一系列用于放置可调节胃束带的LESS手术。本研究旨在确定LESS手术放置可调节胃束带的安全性和可行性。
2007年12月至2008年6月，在获得机构审查委员会批准后，对10例患者行经脐切口的LESS手术放置可调节胃束带。本质上，通过脐部的单个切口放置多个端口，以允许肝脏牵拉、可视化和操作器械。使用标准的松弛部技术进行的所有关键步骤均未改变。
本研究精心挑选了10例患者（9名女性和1名男性）。这些患者年龄在32至61岁之间（平均47岁），平均体重指数（BMI）为42kg/m²（范围为35-45kg/m²）。选择这些患者是因为他们既没有肝肿大也没有中心性肥胖。超级肥胖患者不考虑纳入本研究。平均手术时间为1小时10分钟（范围为53分钟至1小时48分钟）。所有患者在入院后23小时内出院，未观察到围手术期并发症。此外，未发生与伤口相关的并发症。值得注意的是，10例患者中只有2例在从恢复室出院后需要使用麻醉性镇痛药。没有术中或术后并发症。
根据我们的经验，LESS手术放置可调节胃束带对选定的患者来说是可行且安全的。尽管存在技术限制，这些限制将得到改进，但需要进一步研究以比较LESS手术放置可调节胃束带与传统腹腔镜技术。
