Department of Surgery, Division of Gastrointestinal and Endocrine Surgery, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390-8819, USA.
Surg Endosc. 2010 Jun;24(6):1403-12. doi: 10.1007/s00464-009-0786-7. Epub 2009 Dec 25.
Findings have shown that single-incision laparoscopic cholecystectomy (SILC) is feasible and reproducible. The authors have pioneered a two-trocar SILC technique at the University of Texas Southwestern. Their results for 100 patients are presented.
From January 2008 to March 2009, 100 patients with symptomatic gallbladder disease underwent SILC through a 1.5- to 2-cm umbilical incision using a two-port (5-mm) technique. For nearly all the patients, a 30 degrees angled scope was used. The gallbladder was retracted, with two or three sutures placed along the gallbladder. These sutures were either fixated internally or placed through the abdominal wall to obtain a critical view of Calot's triangle. The SILC procedure was performed using standard technique with 5-mm reticulating or conventional laparoscopic instruments. The cystic duct and artery were well visualized, clipped, and divided. Cholecystectomy was completed with electrocautery, and the specimen was retrieved through the umbilical incision.
In this series, 80 women (85%) and 15 men (15%) with an average age of 33.8 years (range, 17-66 years) underwent SILC. Their mean BMI was 29.8 kg/m(2) (range, 17-42.5 kg/m(2)), and 39% of these patients had undergone previous abdominal surgery. The mean operative time was 50.8 min (range, 23-120 min). The mean estimated blood loss was 22.3 ml (range, 5-125 ml), and 5% of the patients had an intraoperative cholangiogram. There were no conversions of the SILC technique. A two-trocar technique was feasible for 87% of the patients. For the remaining patients, either a three-channel port or three individual trocars were required. A SILC technique was used for 5% of the patients to manage acute cholecystitis or gallstone pancreatitis.
The SILC technique with a two-trocar technique is safe, feasible, and reproducible. The operating times are reasonable and can be lessened with experience. Even complex cases can be managed with this technique. Excellent exposure of the critical view was obtained in all cases. The SILC procedure is becoming the standard of care for most of the authors' elective patients with gallbladder disease. Clinical trials are warranted before the SILC technique is adopted universally.
研究结果表明，单切口腹腔镜胆囊切除术（SILC）是可行和可重复的。作者在德克萨斯大学西南医学中心首创了一种两套管（5mm）SILC 技术。他们报道了 100 例患者的结果。
从 2008 年 1 月至 2009 年 3 月，100 例有症状的胆囊疾病患者通过脐部 1.5-2cm 切口，使用两套管（5mm）技术进行 SILC。几乎所有患者均使用 30 度角镜。胆囊被牵拉，沿胆囊放置两到三个缝线。这些缝线要么固定在内侧，要么穿过腹壁以获得 Calot 三角的关键视图。使用标准技术和 5mm 网格或常规腹腔镜器械进行 SILC 操作。胆囊管和胆囊动脉均清晰可见，夹闭并切断。使用电烙术完成胆囊切除术，标本通过脐部切口取出。
本系列中，80 名女性（85%）和 15 名男性（15%），平均年龄 33.8 岁（17-66 岁），接受 SILC。他们的平均 BMI 为 29.8kg/m2（17-42.5kg/m2），其中 39%的患者有过腹部手术史。平均手术时间为 50.8 分钟（23-120 分钟）。平均估计出血量为 22.3ml（5-125ml），5%的患者术中行胆管造影。无 SILC 技术转换。对于 87%的患者，两套管技术是可行的。对于其余患者，需要三通道端口或三个单独的套管针。5%的患者使用 SILC 技术治疗急性胆囊炎或胆石性胰腺炎。
两套管 SILC 技术安全、可行且可重复。手术时间合理，经验丰富后可缩短。即使是复杂病例也可以通过这种技术进行处理。所有病例均获得了良好的关键视图暴露。SILC 手术已成为作者治疗大多数胆囊疾病择期患者的标准治疗方法。在 SILC 技术被普遍采用之前，需要进行临床试验。
