Back M, Nimmesgern T, Langwieler T E
Ev. Amalie Sieveking-Krankenhaus, Klinik für Allgemein-, Viszeral- und Unfallchirurgie, Hamburg, Deutschland.
Zentralbl Chir. 2010 Apr;135(2):183-7. doi: 10.1055/s-0029-1224753. Epub 2010 Apr 8.
Nowadays laparoscopy is the approach of choice for the majority of abdominal pathologies. As the emphasis on minimising the technique continues, new methods as natural orifice translumenal endoscopic surgery (NOTES) and, just recently, single port access surgery (SPA) are evolving rapidly. SPA may represent the next generation of minimally invasive surgery as it combines some of the cosmetic advantage of the natural orifice translumenal endoscopic surgery (NOTES) and allows the performance of the surgical procedure with standard surgical instruments. To perform SPA, the abdomen is approached through a 2 cm incision via the umbilicus and a single-port access device is inserted as sole access to the abdomen. Depending on the single-port system, usually a multichannel cannula, two or three laparoscopic instruments can be used at the same time. The special design of the channels prevents gas leakage while changing instruments. There is also an extra channel for the gas insufflation and an additional element for retracting the abdominal wall. Single-port laparoscopic procedures are safe and feasible. Tissue trauma and port-related complications such as organ damage, adhesions, bleedings, wound infections and hernias could be decreased and the cosmesis is comparable with that of NOTES. Additional experience and continued investigation are warranted.
如今，腹腔镜检查是大多数腹部疾病的首选治疗方法。随着对微创技术的持续重视，诸如经自然腔道内镜手术（NOTES）以及最近出现的单孔腹腔镜手术（SPA）等新方法正在迅速发展。单孔腹腔镜手术可能代表了下一代微创手术，因为它结合了经自然腔道内镜手术（NOTES）的一些美容优势，并允许使用标准手术器械进行手术操作。要进行单孔腹腔镜手术，需通过脐部一个2厘米的切口进入腹腔，并插入一个单孔通道装置作为进入腹腔的唯一通道。根据单孔系统的不同，通常是一个多通道套管，可同时使用两到三把腹腔镜器械。通道的特殊设计可防止在更换器械时气体泄漏。还有一个用于气体注入的额外通道以及一个用于牵拉腹壁的附加部件。单孔腹腔镜手术是安全可行的。组织创伤以及与穿刺孔相关的并发症，如器官损伤、粘连、出血、伤口感染和疝气等情况均可减少，而且美容效果与经自然腔道内镜手术相当。还需要更多的经验和持续的研究。
