Pietrasanta Dario, Romano Nicola, Prosperi Valerio, Lorenzetti Luca, Basili Giancarlo, Goletti Orlando
General Surgery Unit, "F. Lotti" Hospital, Pontedera (Pisa), Italy.
Updates Surg. 2010 Oct;62(2):111-5. doi: 10.1007/s13304-010-0023-x. Epub 2010 Sep 25.
The rationale for single-incision laparoscopic surgery (SILS) is minimizing morbidity, as well as improving cosmetic results of laparoscopic approach. This technique has been used for a variety of procedures and has recently been proposed for colonic resections as well. We report our preliminary experience of right colectomy, performed through a SILS approach. Five patients (3 males, 2 females, mean age 81.6 years) were selected to undergo SILS right colectomy for cancer. The procedure was carried out through a SILS multi-port device (SILS™ Port, Covidien Ltd, Norwalk, CT, USA), with either conventional or specially designed instruments. A medial-to-lateral approach and an extra-corporeal anastomosis were performed. In three cases, the procedure was completed through the SILS technique; in two of these cases a combined procedure was carried out (right colectomy plus cholecystectomy, right colectomy plus cholecystectomy plus i.o. colonoscopy and polypectomy). In one case, a switch to standard laparoscopy was necessary because of the large dimension of the tumour, while in the other case an intolerance of pneumoperitoneum was registered, thus requiring a conversion to open surgery. SILS procedures proved to be oncologically correct. No major complications occurred. In selected patients, SILS right colectomy for cancer appears to be feasible and oncologically safe. Beyond the cosmetic advantage, the procedure may reduce postoperative morbidity. Further studies are needed, with larger series and a longer follow-up, to determine the incidence of possible long-term complications and to evaluate possible cost-effectiveness of the procedure.
单孔腹腔镜手术（SILS）的基本原理是将发病率降至最低，并改善腹腔镜手术的美容效果。该技术已应用于多种手术，最近也被提议用于结肠切除术。我们报告了通过SILS方法进行右半结肠切除术的初步经验。选择5例患者（3例男性，2例女性，平均年龄81.6岁）接受SILS右半结肠切除术治疗癌症。手术通过SILS多端口装置（SILS™ Port，美国科惠医疗公司，康涅狄格州诺沃克）进行，使用传统器械或专门设计的器械。采用由内侧向外侧的入路和体外吻合术。3例手术通过SILS技术完成；其中2例进行了联合手术（右半结肠切除术加胆囊切除术、右半结肠切除术加胆囊切除术加术中结肠镜检查及息肉切除术）。1例因肿瘤体积较大而转为标准腹腔镜手术，另1例出现气腹不耐受，因此需要转为开放手术。SILS手术在肿瘤学上是正确的。未发生重大并发症。在选定的患者中，SILS右半结肠癌切除术似乎是可行的，且在肿瘤学上是安全的。除了美容优势外，该手术还可能降低术后发病率。需要进一步开展更大样本量、更长随访时间的研究，以确定可能的长期并发症发生率，并评估该手术可能的成本效益。
