Mofid Hamid, Zornig Carsten
Department of Surgery, Israelitisches Krankenhaus in Hamburg, Hamburg, Germany.
Surg Technol Int. 2010 Apr;19:61-4.
The objective of this study was to achieve an ideal cosmetic result and minimize the access trauma to the abdominal wall. The authors developed a technique to perform cholecystectomies and appendectomies with only one incision in the umbilicus. With the upcoming idea of Natural Orifice Transluminal Endoscopic Surgery (NOTES) in the recent years and noticing the lack of feasibility of the technique for the daily routine beside the technique described by these authors, another development was raising the interest of the surgeons around the world. The single-access surgery through the umbilicus is a technique, that can be used in the daily routine and provides the best cosmetic results. Furthermore, injury of the abdominal wall is located at only one site, which might reduce the rate of trocar hernias and abdominal wall infections. Two 5.5-mm trocars were inserted through an incision at the upper edge of the umbilicus. After perforation of the abdominal wall with a stylet of a 5.5-mm trocar, a curved grasper was inserted, without the use of a trocar, into the abdominal cavity. The use of curved instruments facilitates better triangulation and instrument handling. No gas leakage was observed due to the nonexistence of a trocar. Dissection of the Calot' s triangle or appendix vessels can be done with standard instruments. The curved grasper allows retraction of the gallbladder or appendix. The specimen can be removed through the umbilical incision. The authors present a single-access surgery technique for cholecystectomies and appendectomies using curved instruments. The single-access surgery with parallel inserted curved instruments is feasible. No additional complications are related to this modification other than those known to be associated with laparoscopic surgery. This method offers an almost scarless surgery. Whether other advantages such as less trocar hernias, wound infections, and/or a faster recovery can be achieved, it has not yet to be proven.
本研究的目的是获得理想的美容效果，并将对腹壁的手术创伤降至最低。作者开发了一种技术，仅通过脐部的一个切口来进行胆囊切除术和阑尾切除术。近年来，随着自然腔道内镜手术（NOTES）这一新兴理念的出现，且注意到除了这些作者所描述的技术外，该技术在日常临床应用中缺乏可行性，另一项进展引起了全球外科医生的关注。经脐单孔手术是一种可用于日常临床的技术，能提供最佳的美容效果。此外，腹壁损伤仅位于一个部位，这可能会降低套管针疝和腹壁感染的发生率。通过脐部上缘的一个切口插入两根5.5毫米的套管针。在使用5.5毫米套管针的探针穿透腹壁后，不使用套管针，而是将一个弯形抓钳插入腹腔。使用弯形器械便于更好地进行三角操作和器械操控。由于没有使用套管针，未观察到气体泄漏。可以使用标准器械解剖胆囊三角或阑尾血管。弯形抓钳可用于牵拉胆囊或阑尾。标本可通过脐部切口取出。作者介绍了一种使用弯形器械进行胆囊切除术和阑尾切除术的单孔手术技术。平行插入弯形器械的单孔手术是可行的。除了已知与腹腔镜手术相关的并发症外，这种改良方法没有引发其他额外的并发症。该方法提供了几乎无痕的手术。至于是否能实现其他优势，如减少套管针疝、伤口感染和/或更快康复，还有待证实。
