Podolsky Erica R, Rottman Steven J, Curcillo Paul G
Drexel University, College of Medicine, Department of Surgery, Philadelphia, PA 19107, USA.
JSLS. 2009 Oct-Dec;13(4):528-35. doi: 10.4293/108680809X12589998404245.
Laparoscopy is a constantly evolving field of surgery. New technology, applications, and benefits prompt continual improvement. We have developed a Single Port Access (SPA) surgical technique that allows for the entire cholecystectomy to be performed through a single incision within the umbilicus while maintaining safe standard dissection and retraction techniques of currently performed multiport laparoscopic cholecystectomy.
Fifteen consecutive patients underwent SPA cholecystectomy. Indications were cholelithiasis, cholecystitis, CBD stones, and biliary akinesia. The entire procedure was performed through a single umbilical incision measuring <1.8 cm within the umbilicus. Three trocars and a rigid grasper were inserted through separate fascial sites within the same skin incision. The cholecystectomy procedures are then performed in the standard fashion described in multi-port cholecystectomy.
Fifteen patients successfully underwent Single Port Access cholecystectomy. One patient required a second 5-mm port site secondary to difficulty with retraction of a large liver. Operative times averaged 107 minutes. Blood loss, patient recovery, and outcomes have been comparable to those of standard multi-port procedures. No umbilical hernias have been seen at 2 years of follow-up.
We present the SPA cholecystectomy as an alternative to multi-port cholecystectomy. In the first 2 years, SPA surgery has evolved into a technique easily taught and performed without the restrictions of new equipment or added cost.
腹腔镜手术是一个不断发展的外科领域。新技术、应用和益处促使其持续改进。我们开发了一种单孔入路（SPA）手术技术，该技术可通过脐部的单个切口完成整个胆囊切除术，同时保持当前多端口腹腔镜胆囊切除术的安全标准解剖和牵拉技术。
连续15例患者接受了SPA胆囊切除术。适应证为胆结石、胆囊炎、胆总管结石和胆囊运动障碍。整个手术通过脐部一个小于1.8 cm的单个脐部切口进行。三个套管针和一个硬性抓钳通过同一皮肤切口内不同的筋膜部位插入。然后按照多端口胆囊切除术中描述的标准方式进行胆囊切除手术。
15例患者成功接受了单孔入路胆囊切除术。1例患者因牵拉大肝脏困难，需要在第二个部位做一个5 mm的端口。手术时间平均为107分钟。失血情况、患者恢复情况和手术效果与标准多端口手术相当。随访2年未见脐疝发生。
我们提出将SPA胆囊切除术作为多端口胆囊切除术的一种替代方法。在最初的2年里，SPA手术已发展成为一种易于教授和实施的技术，不受新设备的限制或额外费用的影响。
