Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
J Gastrointest Surg. 2010 Mar;14(3):506-10. doi: 10.1007/s11605-009-1116-z. Epub 2009 Dec 5.
We describe the results of a single surgeon's initial experience with single-incision laparoscopic cholecystectomy through his first 56 cases and provide a brief literature review on the development of this technique.
Through a 2-cm vertical transumbilical incision, three 5-mm ports were placed using the Veress technique. One extracorporeal suture was utilized to provide cephalad retraction of the fundus, and a roticulating instrument grasping the infundibulum provided lateral retraction. The hilum was dissected, and the cystic duct and artery were clipped and divided. One 5-mm port was upgraded to a 10-mm port to allow the introduction of a retrieval bag, and the gallbladder was removed from the abdomen.
Of 56 patients, 54 successfully underwent a single-incision laparoscopic cholecystectomy. Two patients required conversion to either a conventional laparoscopic cholecystectomy or open cholecystectomy. The average age was 41 years (18-77) and the average BMI, 30.2 kg/m(2) (18.5-44.6). Mean operative time was 80 min (41-186). Length of stay was 0.3 days (0-2). The complication rate was 3/56 (5.4%).
Our results suggest that single-incision laparoscopic cholecystectomy is a safe and effective alternative to four-port laparoscopic cholecystectomy that provides surgeons with an alternative minimally invasive surgical option and the ability to hide the surgical incision within the umbilicus.
我们描述了一位外科医生在首例 56 例单切口腹腔镜胆囊切除术的初步经验，并对该技术的发展进行了文献回顾。
通过 2cm 的垂直脐部切口，使用 Veress 技术置入三个 5mm 的端口。一个体外缝线用于提供胆囊底部的向上牵引，一个旋转器械抓握胆囊颈提供侧向牵引。解剖胆囊三角，夹闭并切断胆囊管和胆囊动脉。一个 5mm 的端口升级为 10mm 的端口以允许引入取物袋，将胆囊从腹部取出。
56 例患者中，54 例成功实施了单切口腹腔镜胆囊切除术。2 例需要转换为传统腹腔镜胆囊切除术或开腹胆囊切除术。平均年龄为 41 岁（18-77 岁），平均 BMI 为 30.2kg/m²（18.5-44.6）。平均手术时间为 80 分钟（41-186 分钟）。住院时间为 0.3 天（0-2 天）。并发症发生率为 3/56（5.4%）。
我们的结果表明，单切口腹腔镜胆囊切除术是一种安全有效的四孔腹腔镜胆囊切除术替代方法，为外科医生提供了一种替代的微创手术选择，并能够将手术切口隐藏在脐部。
