Department of Pediatric Surgery, Children's Hospital of Alabama, University of Alabama at Birmingham, 1600 7th Avenue South ACC 300, Birmingham, AL 35233, USA.
Surg Endosc. 2010 Jul;24(7):1589-93. doi: 10.1007/s00464-009-0816-5. Epub 2009 Dec 24.
Laparoscopic pyloromyotomy has become the standard treatment for hypertrophic pyloric stenosis. Single-incision laparoscopic surgery is an emerging operative approach that utilizes the umbilical scar to hide the surgical incision.
To describe our initial experience with single-incision laparoscopic pyloromyotomy in 15 infants.
Laparoscopic pyloromyotomy was performed through a single skin incision in the umbilicus, using a 4-mm 30 degrees endoscope and a 5-mm trocar. The 3-mm working instruments were inserted directly into the abdomen via separate lateral fascial stab incisions. All patients were prospectively evaluated.
The procedure was performed in 15 infants (13 male) with mean age of 45 +/- 16 days and mean weight of 4.04 +/- 0.5 kg. All procedures were completed laparoscopically, and one case was converted to a conventional triangulated laparoscopic work configuration after a mucosal perforation was noted. The perforation was repaired laparoscopically. On average, operating time was 29.8 +/- 13.6 min, and postoperative length of stay was 1.5 +/- 0.8 days. All patients were discharged home on full feeds. Follow-up was scheduled 2-3 weeks after discharge, and no postoperative complications were noted in any of the patients.
Single-incision laparoscopic pyloromyotomy is a safe and feasible procedure with good postoperative results and excellent cosmesis. The main challenge is the spatial orientation of the instruments and endoscope in a small working space. This can be overcome by a more longitudinally oriented working axis than used in the conventional angulated laparoscopic configuration.
腹腔镜幽门肌切开术已成为肥厚性幽门狭窄的标准治疗方法。单切口腹腔镜手术是一种新兴的手术方法，利用脐部疤痕隐藏手术切口。
描述我们在 15 例婴儿中进行单切口腹腔镜幽门肌切开术的初步经验。
腹腔镜幽门肌切开术通过脐部的单个皮肤切口进行，使用 4mm 30 度内窥镜和 5mm 套管针。3mm 的工作器械通过单独的侧筋膜戳口直接插入腹部。所有患者均进行前瞻性评估。
15 例婴儿（男 13 例）接受了该手术，平均年龄为 45 +/- 16 天，平均体重为 4.04 +/- 0.5kg。所有手术均在腹腔镜下完成，1 例因发现黏膜穿孔而转为常规三角腹腔镜工作构型。穿孔经腹腔镜修复。平均手术时间为 29.8 +/- 13.6 分钟，术后住院时间为 1.5 +/- 0.8 天。所有患者均恢复全肠喂养后出院。出院后 2-3 周进行随访，所有患者均无术后并发症。
单切口腹腔镜幽门肌切开术是一种安全可行的手术方法，具有良好的术后效果和极佳的美容效果。主要挑战是在小工作空间中器械和内窥镜的空间定位。这可以通过比传统角腹腔镜构型更纵向的工作轴来克服。
