Misiak Andrzej, Szczepanik Andrzej B
Department of General and Hematological Surgery, Institute of Hematology and Blood Transfusion, Warsaw, Poland.
Pol Merkur Lekarski. 2009 Nov;27(161):372-4.
For the last seventeen years laparoscopic cholecystectomy has remained the gold standard procedure for gallbladder surgery The single incision laparoscopic surgery (SILS) approach is a step toward less invasive surgery and the intraumbilical access improves the cosmetic effect (no scar surgery). The aim of the study was to present our preliminary experience in laparoscopic cholecystectomy through single intraumbilical incision.
Three patients with gallbladder symptoms (2 female, 1 male) underwent surgery through single intraumbilical incision. In two cases the procedure was performed with three 5 mm Dexide port approach and in one, with a flexible rubber/gel SILSTM-Port (Covidien, USA) access. A simple 5 mm optics was employed. In two procedures the following disposable instruments were used: roticulator Endo dissect, roticulator Endo grasp, mini Sears scissors as well as standard hook and clips while for the third procedure, a conventional multi-use grasp and roticular Endo dissect. The gallbladder was elevated to the integuments by two sutures to expose Calot's triangle and bladder site. Following exposure, the bile duct and the vesical artery were clipsed and cut routinely to remove the gallbladder in a plastic bag through the bell-button. After procedures no drains were left in the peritoneal cavities.
In all three cases the laparoscopic procedure was performed. The median operative time was 88 min. In one female patient, bleeding into the peritoneal cavity was reported and called for laparotomy within a few hours of laparoscopic procedure. Intraoperatively, the branch of vesical artery was sutured to arrest bleeding. The median hospital stay following procedure was 3, 8 and 5 days respectively. After the procedure, the last female patient was observed to have pharyngitis and enlarged jugular lymph nodes that abated after antibiotic therapy.
Single-incision laparoscopic cholecystectomy should be performed by experienced laparoscopic surgeons. For adequate evaluation of the efficacy and safety of this procedure it is necessary to perform further clinical studies on a larger number of patients.
在过去的十七年里，腹腔镜胆囊切除术一直是胆囊手术的金标准术式。单切口腹腔镜手术（SILS）方法是迈向微创手术的一步，脐部入路改善了美容效果（无痕手术）。本研究的目的是介绍我们通过单脐部切口进行腹腔镜胆囊切除术的初步经验。
三名有胆囊症状的患者（2名女性，1名男性）通过单脐部切口接受手术。两例手术采用三个5毫米德赛端口入路，一例采用柔性橡胶/凝胶SILSTM端口（美国柯惠公司）入路。使用了一个简单的5毫米光学镜头。两例手术使用了以下一次性器械：旋转式内镜解剖器、旋转式内镜抓钳、迷你西尔斯剪刀以及标准钩和夹子，而第三例手术使用了传统的多用抓钳和旋转式内镜解剖器。通过两根缝线将胆囊提升至体表以暴露胆囊三角和胆囊部位。暴露后，常规夹闭并切断胆管和胆囊动脉，通过脐孔将胆囊装入塑料袋取出。手术后，腹腔内未留置引流管。
所有三例均成功完成腹腔镜手术。中位手术时间为88分钟。一名女性患者报告腹腔内出血，在腹腔镜手术后数小时内需要开腹手术。术中，缝合胆囊动脉分支以止血。术后中位住院时间分别为3天、8天和5天。手术后，最后一名女性患者出现咽炎和颈淋巴结肿大，抗生素治疗后缓解。
单切口腹腔镜胆囊切除术应由经验丰富的腹腔镜外科医生进行。为了充分评估该手术的有效性和安全性，有必要对更多患者进行进一步的临床研究。
