Department of Surgery, University of California, San Diego, 200 West Arbor Drive, 8402, San Diego, CA, USA.
Surg Endosc. 2011 Feb;25(2):586-92. doi: 10.1007/s00464-010-1225-5. Epub 2010 Aug 24.
Single-port and incisionless surgical approaches hold the promise of fewer complications, reduced pain, faster recovery, and improved cosmesis compared with traditional open or laparoscopic approaches. The ability to select an access approach (i.e., endolumenal, single-port, transvaginal, or transgastric) with one platform may be important to optimization of individual patient results. The authors report their results using these four separate surgical approaches tailored to three different therapeutic procedures, all with the use of a single flexible platform, the Incisionless Operating Platform (IOP).
After institutional review board approval, the IOP was used to perform nine cholecystectomies via transvaginal (TV) (n=4), transgastric (TG) (n=4), and single-port transumbilical (TU) (n=1) access. Two appendectomies were performed via TG access. Endolumenal access was used for 18 gastric pouch and stoma reductions after Roux-en-Y gastric bypass. The TG and TV procedures involved the use of one to three trocars. The recorded data included safety, procedural success, operative time, patient pain assessment (on a 0-10 scale) at discharge, and length of hospital stay.
Procedural success was achieved for 16 of 18 endolumenal procedures, 1 of 1 single-port procedure, and 10 of 10 NOTES procedures. For 5 of 10 NOTES procedures, only one small trocar was required. The mean operative times were 79 min for pouch with stoma reduction, 171 min for cholecystectomy, and 274 min for appendectomy. Of 29 patients, 27 were discharged in 24 h or less. The average pain scores were 0.44 for pouch with stoma reduction, 1.3 for cholecystectomy, and 2.5 for appendectomy. No significant complications occurred. The ergonomics of IOP allowed the surgeon to interface with the system using an endoscopic or laparoscopic orientation.
Availability of a multifunctional, flexible surgery platform provides a choice of a single-port or incisionless surgical approach with the potential to reduce complications, pain, and recovery time while improving cosmesis.
与传统的开放式或腹腔镜式方法相比，单孔和无切口手术方法有望减少并发症、减轻疼痛、加快恢复速度和改善美容效果。能够使用一个平台选择一种入路方法（即腔内、单孔、经阴道或经胃）对于优化个体患者的结果可能很重要。作者报告了他们使用这四种不同的手术方法治疗三种不同治疗方法的结果，所有这些方法均使用单个灵活平台——无切口手术操作平台（IOP）。
在机构审查委员会批准后，使用 IOP 通过经阴道（TV）（n=4）、经胃（TG）（n=4）和经脐单孔（TU）（n=1）入路进行了 9 例胆囊切除术。通过 TG 入路进行了 2 例阑尾切除术。经内镜入路用于 18 例 Roux-en-Y 胃旁路术后胃袋和吻合口缩小。TG 和 TV 手术涉及使用 1 至 3 个套管针。记录的数据包括安全性、手术成功率、手术时间、患者出院时疼痛评估（0-10 分）和住院时间。
18 例经内镜手术中 16 例成功，1 例单孔手术成功，10 例NOTES 手术中 9 例成功。10 例NOTES 手术中，仅 5 例需要一个小套管针。胃袋和吻合口缩小的平均手术时间为 79 分钟，胆囊切除术为 171 分钟，阑尾切除术为 274 分钟。29 例患者中，27 例在 24 小时或更短时间内出院。平均疼痛评分分别为胃袋和吻合口缩小 0.44 分、胆囊切除术 1.3 分、阑尾切除术 2.5 分。无明显并发症发生。IOP 的人体工程学设计允许外科医生使用内镜或腹腔镜方向与系统进行交互。
多功能、灵活的手术平台的可用性提供了单孔或无切口手术方法的选择，有可能减少并发症、疼痛和恢复时间，同时改善美容效果。
