Department of Surgery, Baystate Medical Center, Tufts University School of Medicine, 759 Chestnut Street, Springfield, MA 01199, USA.
Surg Endosc. 2010 Jun;24(6):1374-9. doi: 10.1007/s00464-009-0781-z. Epub 2009 Dec 29.
As surgeons embrace the concept of increasingly less invasive surgery, techniques using only a single small incision have begun to gain traction. Several commercially available products have emerged recently. The TriPort system and the SILS Port are single-port devices that allow the surgeon to perform laparoscopic surgery through a 2- to 3-cm periumbilical incision. This study aimed to ascertain whether these devices allow safe and reliable access for laparoscopic cholecystectomy.
From March 2008 to June 2009, single-port laparoscopic cholecystectomy was attempted for 22 patients with an average age of 40 years (range, 23-73 years). The data collected prospectively after institutional review board approval included demographics, operative time, complications, and reasons for conversion to standard four-port laparoscopic surgery.
The operation was completed successfully for 21 of the 22 patients (15 women and 7 men) using five different techniques. The mean body mass index (BMI) of the patients was 32.7 kg/cm(2) (range, 22.3-46.1 kg/cm(2)). Three of the patients had previously undergone laparoscopic Roux-en-Y gastric bypass. The mean operative time was 80.8 min (range, 51-156 min). One patient experienced a Richter's hernia postoperatively, which required a reoperation and subsequent bowel resection. One patient required conversion to a standard four-port laparoscopic cholecystectomy because the articulating instrument could not reach the gallbladder from the umbilicus.
The results from the current series show single-port laparoscopic cholecystectomy to be a promising technique. A variety of patient demographics appear suited to this approach. The operative time in this series compares favorably with that for the standard four-port operation. The feasibility of single-port laparoscopic cholecystectomy is now established. However, routine application of this novel technique requires an evaluation of its safety and cost effectiveness in larger studies. In addition, its superiority over standard laparoscopic cholecystectomy in terms of postoperative pain, cosmesis, and overall patient satisfaction requires further study. Refinements in instrumentation will enable wider use of this novel minimally invasive approach.
随着外科医生接受越来越微创的手术理念，仅使用单个小切口的技术开始受到关注。最近出现了几种商业上可用的产品。TriPort 系统和 SILS Port 是单端口设备，允许外科医生通过脐部 2-3cm 的切口进行腹腔镜手术。本研究旨在确定这些设备是否允许安全可靠地进行腹腔镜胆囊切除术。
从 2008 年 3 月至 2009 年 6 月，对 22 例平均年龄为 40 岁（范围 23-73 岁）的患者尝试进行单端口腹腔镜胆囊切除术。在机构审查委员会批准后，前瞻性收集的数据包括人口统计学、手术时间、并发症以及转为标准四端口腹腔镜手术的原因。
22 例患者中的 21 例（15 名女性和 7 名男性）成功完成了手术，使用了五种不同的技术。患者的平均体重指数（BMI）为 32.7kg/cm²（范围 22.3-46.1kg/cm²）。其中 3 例患者曾行腹腔镜 Roux-en-Y 胃旁路术。平均手术时间为 80.8 分钟（范围 51-156 分钟）。1 例患者术后发生 Richter 疝，需再次手术和随后的肠切除术。1 例患者因从脐部无法到达胆囊而需要转为标准四端口腹腔镜胆囊切除术。
本系列研究结果表明单端口腹腔镜胆囊切除术是一种很有前途的技术。各种患者人群似乎都适合这种方法。本系列的手术时间与标准四端口手术相当。单端口腹腔镜胆囊切除术的可行性已得到证实。然而，在更大的研究中评估其安全性和成本效益，需要常规应用这项新技术。此外，它在术后疼痛、美容效果和整体患者满意度方面优于标准腹腔镜胆囊切除术，这需要进一步研究。器械的改进将使这种新的微创方法得到更广泛的应用。
