Department of Urology and Andrology, LandesKrankenhaus Hall i. T., Milser Str. 10, 6060 Hall i. T., Austria.
World J Urol. 2012 Oct;30(5):613-8. doi: 10.1007/s00345-011-0670-7. Epub 2011 Apr 2.
New transumbilical laparoendoscopic procedures are an emerging field in urologic surgery. We introduced the concept of single-incision triangulated umbilical surgery (SITUS) in 2009. SITUS technique uses straight optics and instruments in a triangulated fashion via three trocars placed through an umbilical incision resulting in a familiar laparoscopic environment. Aim of the study was to demonstrate the feasibility of SITUS in simple and radical nephrectomy in daily routine.
From October 2009 to July 2010, in 3 patients with cirrhotic kidneys a simple and in 12 patients a radical nephrectomy was performed in SITUS technique. The umbilical fold was incised at three-fourth of its circumference; in the patient with radical nephrectomy, additionally small "c"-shaped skin flaps were removed. After achieving a pneumoperitoneum by Verres technique, a 5-mm camera port and then a cranial 5 mm and a caudal 11 mm working trocar were placed with at a distance of 5-10 cm with the aid of two Langenbeck hooks, thus allowing triangulation except in the radical nephrectomy patients, where an 11-mm caudal trocar (Endopath, Ethicon, Hamburg, GER) was used. Using long conventional laparoscopic instruments, En-Seal pressure coagulator and dissector (Erbe, Tuebingen, Germany), Hem-O-Lock clips (Weck, Teleflex, USA), and a 30° 5-mm optic (Karl Storz, Tuttlingen, GER), the interventions were executed like conventional laparoscopic transperitoneal procedures.
OR time was mean 127 min [120, 153] for cirrhotic kidney nephrectomy group and mean 137 min [91, 185] in the radical nephrectomy group. Mean hemoglobin drop was 1.5 g/dl [1.2, 1.7] in benign cases and 2.4 [1.1, 4.9] in radial nephrectomies. All except one diabetic patient with wound infection had an uneventful follow-up without postoperative complications. The patients were discharged at postoperative day 5 [3, 29].
SITUS technique for simple and radical nephrectomy is an attractive alternative to conventional laparoscopy and single-port surgery. It combines the common principles of traditional laparoscopy (straight instruments and triangulation) with single-port surgery (cosmesis and minimally invasiveness) resulting in adequate or time and short learning curve.
新的经脐腹腔镜手术是泌尿外科手术中的一个新兴领域。我们在 2009 年提出了单切口三角脐部手术（SITUS）的概念。SITUS 技术通过在脐部切口处放置三个套管针，以三角形方式使用直式光学和器械，形成熟悉的腹腔镜环境。本研究旨在证明 SITUS 在日常简单和根治性肾切除术中的可行性。
2009 年 10 月至 2010 年 7 月，3 例肝硬化肾脏患者行简单肾切除术，12 例行根治性肾切除术。脐部褶皱在其周长的四分之三处切开；在根治性肾切除术中，另外切除小的"C"形皮瓣。采用 Verres 技术建立气腹后，放置 5mm 摄像头套管针，然后在颅侧放置 5mm 和尾侧 11mm 的工作套管针，在两个 Langenbeck 钩的辅助下，以 5-10cm 的距离形成三角形，除根治性肾切除患者外，还使用 11mm 尾侧套管针（Endopath，Ethicon，汉堡，德国）。使用长传统腹腔镜器械、En-Seal 压力电凝和剥离器（Erbe，图宾根，德国）、Hem-O-Lock 夹（Weck，Teleflex，美国）和 30°5mm 光学镜（Karl Storz，图特林根，德国），像传统腹腔镜经腹腔手术一样进行干预。
肝硬化肾脏切除术组的手术时间平均为 127 分钟[120，153]，根治性肾切除术组为 137 分钟[91，185]。良性病例的平均血红蛋白下降 1.5g/dl[1.2，1.7]，根治性肾切除术为 2.4g/dl[1.1，4.9]。除 1 例糖尿病合并伤口感染的患者外，其余患者均无术后并发症，随访顺利。患者于术后第 5 天出院[3，29]。
SITUS 技术用于简单和根治性肾切除术是传统腹腔镜和单孔手术的一种有吸引力的替代方法。它结合了传统腹腔镜（直器械和三角）的共同原则和单孔手术（美容和微创），从而达到适当的手术时间和较短的学习曲线。
