Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka 565-0871, Japan.
Surg Endosc. 2010 Sep;24(9):2321. doi: 10.1007/s00464-010-0948-7. Epub 2010 Feb 23.
Transumbilical single-incision laparoscopic surgery is an emerging concept that could offer excellent cosmetic results [1]. The authors describe an index case of curatively intended resection of early-stage sigmoid colon cancer using this technique [2, 3].
A 75-year-old woman with a body mass index of 24 underwent surgery by two colorectal surgeons who had hundreds of experiences with laparoscopic colorectal surgery. Three 5-mm ports were placed linearly in the vertical 2-cm skin incision in the umbilicus. Almost all the procedures were performed with usual laparoscopic instruments such as a 5-mm flexible laparoscope and the Harmonic ACE (Ethicon Endo-Surgery, Cincinnati, OH, USA). Also, the operative procedures were much the same as in usual laparoscopic surgery. The sigmoid colon was mobilized using a medial approach. Then the root of the superior rectal artery and inferior mesenteric vein were divided using the EnSeal tissue sealing and hemostasis system (SurgRx, Inc. Redwood City, CA, USA). Low-profile trocars were mandatory to minimize interferences among instruments. The rectum was divided 5 cm distal to the lesion with one firing of an endoscopic stapler. The specimen was extracted through a 2-cm transumbilical laparotomy. End-to-side anastomosis using a circular stapler was performed intraabdominally, and air tightness was confirmed by the anastomotic leak test.
The operative time was 192 min. There was no intra- or postoperative morbidity. Altogether, 20 cm of sigmoid was resected with negative tumor margins, and 14 lymph nodes were harvested. The patient started receiving meals and was discharged on postoperative days 2 and 7, respectively. The final pathology showed Tis, N0, M0, stage 0. The scar was invisible at 1 month.
Single-incision laparoscopic colectomy is feasible and safe for selected patients and gives a favorable cosmetic result. By well-trained surgeons, this technique could be a realistic option for colorectal cancer surgery.
经脐单切口腹腔镜手术是一种新兴的概念，它可以提供极好的美容效果[1]。作者描述了一例使用该技术进行根治性早期乙状结肠癌切除术的病例[2,3]。
一位 75 岁的女性，体重指数为 24，由两位具有数百例腹腔镜结直肠手术经验的结直肠外科医生进行手术。三个 5 毫米的端口以线性方式放置在脐部 2 厘米的垂直皮肤切口处。几乎所有的手术都是使用通常的腹腔镜器械进行的，如 5 毫米的柔性腹腔镜和 Harmonic ACE（Ethicon Endo-Surgery，Cincinnati，OH，USA）。同样，手术过程与通常的腹腔镜手术非常相似。乙状结肠采用内侧入路游离。然后使用 EnSeal 组织密封和止血系统（SurgRx，Inc.，Redwood City，CA，USA）切断直肠上动脉根部和肠系膜下静脉根部。使用低轮廓的套管以尽量减少器械之间的干扰。使用内镜吻合器在距病变 5 厘米处横断直肠。标本通过脐部 2 厘米的小切口取出。在腹腔内进行端侧吻合，通过吻合口漏测试确认气密封性。
手术时间为 192 分钟。无术中或术后并发症。总共切除了 20 厘米的乙状结肠，肿瘤边缘阴性，采集了 14 个淋巴结。患者开始进食，并分别于术后第 2 天和第 7 天出院。最终病理显示Tis、N0、M0、0 期。1 个月后疤痕不可见。
单切口腹腔镜结肠切除术对选定的患者是可行和安全的，并能获得良好的美容效果。经过训练有素的外科医生，该技术可能成为结直肠癌手术的一种现实选择。
