Department of Digestive Surgery, Saku Central Hospital, Saku-City, Nagano, Japan.
Dis Colon Rectum. 2010 Jun;53(6):944-8. doi: 10.1007/DCR.0b013e3181d5e2ee.
In single-access laparoscopic colectomy, the number of forceps inserted through the umbilical incision is limited. To compensate for the single-access site, triangulation must be lost or instrument collision must be sustained. Extracorporeal magnetic retraction can overcome this problem. This report describes the use of this new procedure for colon cancer resection.
All patients had advanced cancer of the descending or the ascending colon. Single access to the abdomen was achieved with a 3.0- to 4.0-cm umbilical incision. Short vascular forceps and 2 rolls of gauze were inserted into the incision and a columnar magnet was placed on the surface of the abdominal wall. A specially made port access device was attached at the incision. The vascular forceps grasping the tissue were retracted by moving the magnet, enabling triangulation in cooperation with a second forceps. The mesocolon was dissected using a medial to lateral approach. The roots of the vascular pedicles were isolated and divided from the superior or the inferior mesenteric artery during lymph node dissection. Extracorporeal anastomosis was performed.
There were no intraoperative complications, no need to convert to open surgery, and no need to add a second port. The median total surgical time was 255 (range, 220-315) minutes. Surgical blood loss was slight (range, 1-20 mL) in all patients. No postoperative complications occurred. The postoperative hospital stay was 7 days for each patient.
This procedure can be safely and feasibly performed using extracorporeal magnetic retraction.
在单通道腹腔镜结肠切除术，插入通过脐部切口的器械数量有限。为了弥补单通道部位的不足，必须失去三角关系或承受器械碰撞。体外磁牵引可以克服这个问题。本报告介绍了这种新方法在结肠癌切除术中的应用。
所有患者均患有降结肠或升结肠癌。经 3.0-4.0cm 脐部切口实现单通道入腹。短血管夹和 2 卷纱布被插入切口，柱状磁铁放置在腹壁表面。在切口处附加一个特制的端口接入装置。通过移动磁铁来牵引夹取组织的血管夹，从而与第二把血管夹配合实现三角关系。采用从内侧向外侧的方法解剖横结肠系膜。在淋巴结清扫过程中，从肠系膜上动脉的上方或下方游离并分离血管蒂。进行体外吻合。
无术中并发症，无需中转开腹，也无需增加第二个端口。中位总手术时间为 255 分钟（范围为 220-315 分钟）。所有患者的手术出血量均较少（范围为 1-20 毫升）。无术后并发症发生。每位患者的术后住院时间为 7 天。
使用体外磁牵引可以安全、可行地进行该手术。
