Department of General Surgery, Soong Ching Ling Grace Hospital, 28 West Jian Kang Road, Chao Hu, 238000, People's Republic of China.
Surg Endosc. 2011 May;25(5):1472-6. doi: 10.1007/s00464-010-1416-0. Epub 2010 Oct 26.
Single-incision laparoscopic surgery has received increasing attention recently. This report describes a novel technique for single-incision laparoscopic appendectomy.
From August 2008 to October 2009, 69 consecutive patients with acute appendicitis underwent gasless single-incision laparoscopic appendectomy under epidural anesthesia at our department. An approximately 1.8-cm-long incision was made at McBurney's point. Once the abdominal wall was entered, an abdominal wall lifting device was employed in the right lower quadrant to lift up the abdominal wall to establish the operating space. Appendectomies were accomplished by use of three techniques: extracorporeally, combined extra- and intracorporeally, and intracorporeally. A drainage tube was inserted in right iliac fossa through the small incision when severe inflammation at the base of appendix or local peritonitis was present at time of operation.
Of the 69 patients, 66 underwent successful gasless single-incision laparoscopic appendectomy. In the remaining three patients the procedure was converted to open by extending the length of the incision at McBurney's point. Average operative time was 51 min (range 38-72 min). Abdominal cavity was drained in four patients. Patients resumed mobility within 24 h postoperatively. No complications occurred intraoperatively. Postoperative complication occurred in two patients: localized abscess in one, and wound infection in another; both were treated successfully with conservative management.
Appendectomy can be safely performed through gasless single-incision laparoscopic surgery. Further study is required to investigate any potential advantage of this method over conventional laparoscopic techniques.
单切口腹腔镜手术最近受到越来越多的关注。本报告介绍了一种新的单切口腹腔镜阑尾切除术技术。
2008 年 8 月至 2009 年 10 月，我科在硬膜外麻醉下对 69 例急性阑尾炎患者行非气腹单切口腹腔镜阑尾切除术。在麦氏点做一个大约 1.8 厘米长的切口。一旦进入腹壁，在右下象限使用腹壁提升装置提起腹壁以建立操作空间。采用三种技术完成阑尾切除术：体外、体外联合体内和体内。如果阑尾根部炎症严重或术中局部腹膜炎，通过小切口在右髂窝插入引流管。
69 例患者中，66 例成功完成非气腹单切口腹腔镜阑尾切除术。其余 3 例患者因麦氏点切口延长而改行开放手术。平均手术时间为 51 分钟（38-72 分钟）。4 例患者行腹腔引流。患者术后 24 小时内恢复活动。术中无并发症发生。术后 2 例患者发生并发症：1 例局部脓肿，1 例伤口感染，均经保守治疗成功。
非气腹单切口腹腔镜手术可安全进行阑尾切除术。需要进一步研究以探讨该方法与传统腹腔镜技术相比的潜在优势。
