Indiana University Department of Surgery, Indianapolis, Indiana, USA.
Dis Colon Rectum. 2010 Nov;53(11):1467-72. doi: 10.1007/DCR.0b013e3181f23ca0.
Single-port laparoscopic surgery has evolved from an effort to minimize tissue trauma, limit morbidity, and maximize cosmesis. Limited data exist comparing single-port with conventional laparoscopy for right colectomy. Our aim is to compare single-port with laparoscopic colectomy with regard to safety and feasibility. We assert that this approach can be adopted in a safe and efficacious manner while using standard laparoscopic instrumentation.
This is a retrospective analysis of prospectively gathered data regarding 16 single-port and 27 conventional laparoscopic right hemicolectomies performed by a single surgeon between January 2008 and February 2009. Demographics, operative outcomes, and morbidity were included and analyzed using either Student t test or Fisher exact probability test.
Single-port and conventional laparoscopic groups were similar with regard to age, gender, body mass index, prior abdominal surgery, and co-morbidity. Seventy-five percent and 70% of the operations were performed for malignancy in the single-port and the conventional laparoscopy group, respectively (P = .69). Operative duration was 106 minutes in the single-port group vs 100 minutes in the conventional group (P = .64). Blood loss was 54 mL and 90 mL, respectively (P = .07). No conversions or additions of ports occurred. Hospital stay was 5.3 days in the single-port group vs 6 days in the conventional group (P = .53). Margins were negative in both groups. Mean lymph node number was 18 and 16 nodes (P = .92). There was one death in the conventional group (P = .44). Morbidity including wound infection was 18.8% and 14.9%, respectively (P = .73).
These findings support single-port right colectomy as a safe and efficacious approach to right colon resections in patients eligible for laparoscopy with minimal additional equipment or learning curve for experienced laparoscopic colorectal surgeons. The single port was undertaken without an increase in morbidity or mortality. There was no increase in operative time with use of the single-port approach. Finally, adequate lymph node harvest and margin clearance was maintained.
单孔腹腔镜手术的发展源于减少组织创伤、降低发病率和最大化美容效果的努力。关于右结肠切除术的单孔与传统腹腔镜比较，相关数据有限。我们的目的是比较单孔与腹腔镜结肠切除术的安全性和可行性。我们断言，在使用标准腹腔镜器械的情况下，这种方法可以安全有效地采用。
这是一项回顾性分析，对 2008 年 1 月至 2009 年 2 月期间，一位外科医生进行的 16 例单孔和 27 例传统腹腔镜右半结肠切除术的前瞻性收集数据进行分析。使用学生 t 检验或 Fisher 确切概率检验，纳入并分析人口统计学、手术结果和发病率。
单孔组和传统腹腔镜组在年龄、性别、体重指数、既往腹部手术和合并症方面相似。75%和 70%的手术分别为单孔组和传统腹腔镜组的恶性肿瘤（P =.69）。单孔组的手术时间为 106 分钟，传统腹腔镜组为 100 分钟（P =.64）。术中出血量分别为 54ml 和 90ml（P =.07）。无中转或附加端口。单孔组的住院时间为 5.3 天，传统腹腔镜组为 6 天（P =.53）。两组切缘均为阴性。平均淋巴结数分别为 18 个和 16 个（P =.92）。传统腹腔镜组有 1 例死亡（P =.44）。包括伤口感染在内的发病率分别为 18.8%和 14.9%（P =.73）。
这些发现支持单孔右结肠切除术作为一种安全有效的方法，适用于有腹腔镜适应证的患者进行右结肠切除术，对有经验的腹腔镜结直肠外科医生来说，所需的额外设备或学习曲线最少。使用单孔方法不会增加发病率或死亡率。使用单孔方法不会增加手术时间。最后，维持了足够的淋巴结清扫和切缘清除。
