Branco Anibal W, Kondo William, Stunitz Luciano C, Filho Alcides J B, de George Marco A
Department of Urology, Cruz Vermelha Hospital and Vita Batel Hospital, Curitiba, Parana, Brazil.
BJU Int. 2009 Oct;104(8):1136-42. doi: 10.1111/j.1464-410X.2009.08536.x. Epub 2009 Mar 26.
To evaluate the safety and feasibility of transumbilical laparoscopic surgery using conventional laparoscopic instruments and ports.
Since January 2008 we have been using laparoscopic transumbilical procedures. Patient selection was determined by any situation, pathological or not, for which laparoscopy was deemed appropriate as the standard of care in our practice. Exclusion criteria included patients who had undergone multiple abdominal procedures. The Veress needle was placed through the umbilicus, to allow insufflation with carbon dioxide. A 10-mm trocar was placed in the peri-umbilical site for the laparoscope, followed by placing two additional 5-mm peri-umbilical trocars. The entire procedure was done using conventional laparoscopic instruments. At the end of surgery the trocars were removed and all three peri-umbilical skin incisions were united for specimen retrieval. Patients undergoing surgery using this approach were evaluated prospectively and data were collected during and after surgery for analysis.
Six procedures were performed using this technique (three nephrectomies, one adrenalectomy, one ureterolithotomy and one retroperitoneal mass resection). The mean operative duration and blood loss were 70.5 min and 108.3 mL, respectively. There were no complications during surgery and no patients needed a blood transfusion. Analgesia comprised metamizole (1 g intravenous every 6 h) and ketoprofen (100 mg intravenous every 12 h). The time to first oral intake was 8 h and the mean hospital stay was 28 h.
Laparoscopic transumbilical surgery seems to be feasible and safe even using conventional laparoscopic instruments, and can be considered a potential alternative for traditional laparoscopic urological procedures.
评估使用传统腹腔镜器械和穿刺端口进行经脐腹腔镜手术的安全性和可行性。
自2008年1月起，我们开始采用腹腔镜经脐手术。患者选择取决于任何情况，无论是否为病理性，只要在我们的实践中腹腔镜检查被视为合适的标准治疗方法即可。排除标准包括曾接受多次腹部手术的患者。将Veress针经脐置入，以便注入二氧化碳。在脐周部位置入一个10毫米的套管针用于腹腔镜，随后再置入另外两个5毫米的脐周套管针。整个手术使用传统腹腔镜器械完成。手术结束时，取出套管针，将所有三个脐周皮肤切口缝合在一起用于取出标本。对采用这种方法进行手术的患者进行前瞻性评估，并在手术期间和术后收集数据进行分析。
使用该技术进行了6例手术（3例肾切除术、1例肾上腺切除术、1例输尿管切开取石术和1例腹膜后肿块切除术）。平均手术时间和失血量分别为70.5分钟和108.3毫升。手术期间无并发症发生，无患者需要输血。镇痛药物包括安乃近（每6小时静脉注射1克）和酮洛芬（每12小时静脉注射100毫克）。首次经口进食时间为8小时，平均住院时间为28小时。
即使使用传统腹腔镜器械，腹腔镜经脐手术似乎也是可行和安全的，可被视为传统腹腔镜泌尿外科手术的一种潜在替代方法。
