Department of Surgery, College of Medicine, Drexel University, 219 North Broad Street, 10th Floor, Philadelphia, PA 19107, USA.
J Gastrointest Surg. 2010 May;14(5):759-67. doi: 10.1007/s11605-009-1081-6. Epub 2010 Feb 13.
In April 2007, we performed our first single port access (SPA) surgical procedure. Beginning with simple procedures, we progressed to more complex procedures employing modifications of the initial technique.
Maintaining our abdominal entry technique through a single incision, typically umbilical, we have now successfully performed cholecystectomies, colon resections, small bowel procedures, liver biopsy, splenectomy, adrenalectomy, and surgery of the gastroesophageal junction.
Two procedures have required additional port sites, none has employed transabdominal sutures, and <5% of all procedures have required articulation. Immediate follow-up demonstrates safe completion of multiple procedures with acceptable outcomes of blood loss and hospital stay. Although initial operative times are extended, a decrease is seen following a learning curve. At 2-year follow-up, two hernias developed at the extended incision for colon extraction.
With initial procedures performed in April 2007, we now report 24-month follow-up of a novel laparoscopic approach utilizing standard instrumentation. We demonstrate that SPA surgery is an alternative to multiport procedures with proposed initial benefits of decreased number of incisions and improved cosmesis for the patient. Long-term prospective randomized large case series will be necessary to assess pain, recovery, and hernia formation proving advantages, if any, over multiport laparoscopy.
2007 年 4 月，我们进行了首例单孔通道（SPA）手术。我们从简单的手术开始，通过对初始技术的改进，逐步进行更复杂的手术。
通过单一切口（通常为脐部）保持我们的腹部进入技术，我们现在已经成功地进行了胆囊切除术、结肠切除术、小肠手术、肝活检、脾切除术、肾上腺切除术以及胃食管交界处手术。
有两例手术需要额外的端口，没有一例使用经腹腔缝线，<5%的手术需要关节。立即随访显示，在可接受的出血量和住院时间的情况下，安全完成了多种手术，具有良好的效果。虽然初始手术时间延长，但在学习曲线后会减少。在 2 年的随访中，有两例因结肠取出而在延长的切口处发生疝。
从 2007 年 4 月开始进行初始手术，我们现在报告了一种新的腹腔镜方法的 24 个月随访结果，该方法使用标准器械。我们证明 SPA 手术是一种替代多端口手术的方法，具有减少切口数量和改善患者美观度的初始优势。需要进行长期前瞻性随机大病例系列研究，以评估 SPA 手术相对于多孔腹腔镜手术在疼痛、恢复和疝形成方面是否具有优势。
