Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China.
Hepatobiliary Pancreat Dis Int. 2010 Dec;9(6):629-33.
Transumbilical single-incision laparoscopic cholecystectomy (SILC) is a new procedure. It has been described by some authors as scarless surgery. To our knowledge, however, there has been no study on outpatient SILC. The present study was designed to determine the safety, feasibility and benefits of transumbilical outpatient SILC.
Twenty-two patients underwent transumbilical outpatient SILC at our department from December 2008 to October 2009. In all patients, the preoperative work-up and operation were completed in the outpatient clinic. To perform the operation, a 2- to 2.5-cm semi-circular incision was made around the umbilicus and three 5-mm trocars were inserted separately by direct puncture. A 5-mm flexible laparoscope, an UltraCision harmonic scalpel and curved instruments were used to perform the laparoscopic cholecystectomy (LC) procedure.
All patients except one were operated on successfully. The conversion rate to standard LC was 5%. In the 21 successfully completed patients, the median duration of operation was 56.5 minutes and estimated operative blood loss was 16.2 ml. The time to resume liquid food was 10.8 hours and semi-liquid food was 16.2 hours after the operation. Nine patients went home on the same day, and 12 on the second day after the operation. The mean postoperative hospital observation time was 18.5 hours. Urinary retention was observed in 1 patient. The follow-up was conducted for all patients at 2 weeks after surgery. All patients were satisfied with the good cosmetic effect of the surgery. The total satisfaction rate was 95%.
Outpatient SILC is a safe and feasible technique for operating with fewer scars and reducing perioperative discomfort at the same time. A direct puncture method to insert trocars is technically feasible. Using a flexible laparoscope and curved instruments make the procedure easier and more time-saving.
经脐单孔腹腔镜胆囊切除术（SILC）是一种新的手术方法。一些作者将其描述为无疤痕手术。但据我们所知，尚无关于门诊 SILC 的研究。本研究旨在确定经脐门诊 SILC 的安全性、可行性和优势。
2008 年 12 月至 2009 年 10 月，我科对 22 例患者进行了经脐门诊 SILC。所有患者均在门诊完成术前检查和手术。手术时，在脐周做一个 2-2.5cm 的半圆形切口，直接穿刺置入三个 5mm 套管针。使用 5mm 柔性腹腔镜、超声刀和弯器械进行腹腔镜胆囊切除术（LC）。
除 1 例患者外，其余患者均成功手术。中转标准 LC 率为 5%。在 21 例成功完成的患者中，手术时间中位数为 56.5 分钟，估计术中出血量为 16.2ml。术后恢复流质饮食时间为 10.8 小时，半流质饮食时间为 16.2 小时。9 例患者当天出院，12 例患者术后第 2 天出院。平均术后住院观察时间为 18.5 小时。1 例患者出现尿潴留。所有患者术后 2 周均进行随访。所有患者对手术的良好美容效果均满意，总满意度为 95%。
门诊 SILC 是一种安全可行的技术，具有较少的疤痕和减轻围手术期不适的优势。套管针直接穿刺法在技术上是可行的。使用柔性腹腔镜和弯器械使手术更容易，更省时。
