Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
Surg Endosc. 2011 Mar;25(3):879-82. doi: 10.1007/s00464-010-1287-4. Epub 2010 Aug 20.
To report the clinical experience of transumbilical single-port laparoscopic cholecystectomy (TUSPLC), using a homemade laparoscopic access port composed of two inexpensive and common pieces of equipment readily available in the operating room.
Fifty consecutive patients with gallstones, including ten patients (20%) with acute cholecystitis, underwent single-port laparoscopic cholecystectomy (LC) using a homemade single port composed of a segment of corrugated breathing tube and a pair of surgical gloves. The port was inserted into the umbilicus for simultaneous placement of multiple conventional instruments into the abdominal cavity. All patients underwent dome-down LC using traditional instruments with manually angulated shafts; dissection was done using electrocautery or harmonic scalpel.
All but two procedures were completed uneventfully. Two patients with acute cholecystitis due to dense adhesions in the triangle of Calot necessitated conversion to two- and four-port laparoscopic procedures, respectively. Operative time averaged 73 ± 2 min for chronic cholecystitis and 95 ± 5 min for acute cholecystitis. There were no perioperative port-related or surgical complications, except for two patients who developed wound seroma and recovered after conservative treatment. We found that healing of the umbilical wound left virtually no scar in all patients.
The homemade umbilical port reported in this study is useful for multiple instrument access and allows TUSPLC to be performed safely, with its inherent cosmetic and cost advantages. Further studies of this technique are ongoing.
报告使用自制腹腔镜通道端口行经脐单孔腹腔镜胆囊切除术（TUSPLC）的临床经验，该端口由手术室中两种廉价且常见的设备组成。
连续 50 例胆囊结石患者，包括 10 例（20%）急性胆囊炎患者，使用由一段波纹呼吸管和一副手术手套组成的自制单端口进行单孔腹腔镜胆囊切除术（LC）。将端口插入脐部，同时将多个常规器械放入腹腔。所有患者均采用传统器械行穹窿下 LC，器械轴手动成角；解剖采用电凝或超声刀。
除 2 例外，所有手术均顺利完成。2 例因 Calot 三角致密粘连的急性胆囊炎患者分别需要转换为两孔和四孔腹腔镜手术。慢性胆囊炎的手术时间平均为 73±2min，急性胆囊炎为 95±5min。无围手术期与端口相关或手术并发症，仅 2 例患者发生切口血清肿，经保守治疗后恢复。我们发现，所有患者的脐部切口愈合后几乎没有留下疤痕。
本研究报告的自制脐部端口可用于多器械通道，并允许安全进行 TUSPLC，具有固有的美容和成本优势。正在对此技术进行进一步研究。
