Dapri Giovanni, Bruyns Jean, Himpens Jacques, Cadière Guy Bernard
Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium.
Surg Innov. 2011 Mar;18(1):61-5. doi: 10.1177/1553350610384406. Epub 2010 Nov 7.
The authors report a single-access laparoscopic Nissen fundoplication (SALN) performed with new curved reusable instruments.
A 21-year-old woman sought care for symptomatic grade B esophagitis and hiatal hernia. A reusable 11-mm trocar was inserted in the umbilicus and a 10-mm, 30° angled, nonflexible, standard length scope was used. Curved reusable instruments (Karl Storz-Endoskope) were transumbilically introduced without trocars. The left hepatic lobe was retracted thanks to the distal curve of the grasper. The cruraplasty and wrap were performed using curved needle holder and intracorporeal sutures.
No extraumbilical trocar was necessary. Laparoscopic time was 108 minutes, and umbilical scar length was 16 mm. Discharge was allowed after 48 hours.
SALN is feasible to be performed with curved reusable instruments, which avoid the conflict between the instruments' tips inside the abdomen or between the surgeon's hands outside. Cost of the procedure remains similar to standard laparoscopy because only reusable material is used.
作者报告了使用新型可重复使用的弯曲器械进行的单通道腹腔镜尼氏胃底折叠术（SALN）。
一名21岁女性因有症状的B级食管炎和食管裂孔疝前来就诊。在脐部插入一个可重复使用的11毫米套管针，并使用一个10毫米、30°角、不可弯曲的标准长度腹腔镜。可重复使用的弯曲器械（卡尔史托斯内窥镜）经脐部无套管针插入。由于抓钳的远端弯曲，左肝叶得以牵拉。使用弯曲持针器和体内缝线进行了膈肌成形术和胃底折叠术。
无需额外的脐外套管针。腹腔镜手术时间为108分钟，脐部瘢痕长度为16毫米。48小时后允许出院。
使用可重复使用的弯曲器械进行SALN是可行的，这避免了器械尖端在腹腔内或外科医生手在腹腔外之间的冲突。该手术的成本与标准腹腔镜手术相似，因为仅使用了可重复使用的材料。
