Department of Surgery, Center for the Future of Surgery, University of California, San Diego, CA 92108, USA.
J Gastrointest Surg. 2010 Feb;14(2):404-7. doi: 10.1007/s11605-009-1079-0. Epub 2009 Nov 12.
Surgery is moving towards less invasive and cosmetically superior approaches such as single incision laparoscopy (SIL). While trans-umbilical SIL is gaining popularity, incisions may lead to post-operative deformations of the umbilicus and the possibility of an increased rate of incisional hernias. Access within the pubic hairline allows preservation of the umbilicus and results in a scar which is concealed within the pubic hair.
Supra-pubic single incision cholecystectomy was performed in a 30-year-old patient with symptomatic gallstones. A 2.5-cm transverse incision was placed within the pubic hairline and a subcutaneous tunnel was formed. Three 5-mm ports were introduced into the tunnel and perforated the anterior rectus sheath superior to the skin incision. The surgical procedure was then undertaken with conventional laparoscopic instrumentation. The adjacent 5-mm incisions were merged for gallbladder removal. The entry site was closed under direct vision.
The above procedure was technically feasible and without complication. Operative time was 45 min, and the patient was discharged 5 h post-operatively.
Supra-pubic single incision laparoscopic cholecystectomy may offer a more cosmetically appealing result than standard umbilical access. The operation can be performed by surgeons skilled in single incision techniques with good result.
外科手术正朝着创伤更小、美容效果更好的方向发展，如单切口腹腔镜手术（SIL）。虽然经脐 SIL 越来越受欢迎，但切口可能导致脐部术后变形，并增加切口疝的发生率。耻骨上缘入路可保留脐部，术后疤痕隐藏于阴毛内。
对一名 30 岁有症状胆囊结石的患者施行耻骨上单切口胆囊切除术。在阴毛内做一个 2.5cm 的横切口，并形成皮下隧道。将三个 5mm 端口引入隧道并在前腹壁肌鞘上方穿透皮肤切口。然后使用常规腹腔镜器械进行手术。相邻的 5mm 切口合并切除胆囊。直视下关闭进入部位。
该手术技术可行，无并发症。手术时间为 45 分钟，患者术后 5 小时出院。
耻骨上单切口腹腔镜胆囊切除术可能比标准脐部入路具有更美观的效果。熟练掌握单切口技术的外科医生可以进行这种手术，并取得良好的效果。
