Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44194, USA.
J Endourol. 2011 Mar;25(3):419-24. doi: 10.1089/end.2010.0415. Epub 2011 Feb 14.
To test different sets of prebent instruments and a new reusable access device for laparoendoscopic single-site (LESS) surgery.
Three surgeons with previous experience in LESS performed 12 nephrectomies in six pigs. In all procedures, a multichannel access device (X-CONE) and a 5-mm extra-long telescope were used. Four sets of prebent instruments with different profiles (S-portal) were tested: Standard (one straight scissors and one curved grasper), Cuschieri, Carus, and Leroy set (each of them consisting of two curved instruments with different configurations). Assessment was performed based on both objective (procedure time; time to manage the pedicle; time to free kidney) and subjective parameters (entry/exit of instruments; triangulation; dissection up/down; dissection lateral; retraction; interdependence). The subjective assessment tool used was a Likert type scale (1 = easy to 5 = prohibitive). The access device was assessed by using objective (time to complete insertion of device after skin incision) and subjective (significant air leakage, movement constraint) parameters.
Time to insertion of the X-CONE was <1 minute in all the cases. Surgeons reported significant insufflant leakage in 58% of cases. The procedure was completed in 10/12 (83%) cases. Mean operative time was 8.3 ± 4.2 minutes, being lower for the Carus group (4.5 min) and higher for the standard group (13 min). Among the different sets, the standard one obtained the best mean scores for all subjective parameters.
X-CONE allows easy abdominal access, and its reusable properties represent cost savings for LESS compared with disposable devices. Prebent instruments might also represent attractive low-cost tools for LESS.
测试不同预弯器械套件和一种新的可重复使用的腹腔镜单部位（LESS）手术入路装置。
三位有 LESS 经验的外科医生在 6 头猪身上进行了 12 例肾切除术。所有手术均使用多通道入路装置（X-CONE）和 5mm 超长腹腔镜。测试了 4 套具有不同形态的预弯器械套件（S-portal）：标准套件（一把直剪和一把弯抓钳）、Cuschieri 套件、Carus 套件和 Leroy 套件（每一套均由两把具有不同构型的弯器械组成）。评估基于客观（手术时间、处理蒂部的时间、游离肾脏的时间）和主观参数（器械进出、三角操作、上下分离、左右分离、牵拉、相互依赖性）进行。使用的主观评估工具为 Likert 量表（1=容易至 5=困难）。通过使用客观（皮肤切口后完成器械插入的时间）和主观（明显的漏气、运动受限）参数来评估入路装置。
X-CONE 的插入时间在所有情况下均<1 分钟。有 58%的病例报告存在明显的气漏。10/12（83%）例手术完成。平均手术时间为 8.3±4.2 分钟，Carus 组最短（4.5 分钟），标准组最长（13 分钟）。在不同套件中，标准套件在所有主观参数上的平均得分最高。
X-CONE 可方便地进行腹部入路，与一次性器械相比，其可重复使用的特性可为 LESS 手术节省成本。预弯器械也可能是一种具有吸引力的 LESS 手术低成本工具。
