Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Beijing, China.
Surg Endosc. 2011 Oct;25(10):3286-93. doi: 10.1007/s00464-011-1706-1. Epub 2011 May 2.
Laparoendoscopic single-site (LESS) surgery is an emerging laparoscopic procedure previously used for cholecystectomy and appendectomy. However, few studies have examined LESS liver resection, and its benefits require investigation. This study aimed to evaluate the feasibility and safety of LESS liver resection.
From December 2009 to October 2010, 12 patients were selected for LESS liver resection with institutional review board approval. The LESS technique was performed using a transumbilical TriPort or three 5-mm trocars with a 5-mm linear or flexible laparoscope. Conventional or articulating laparoscopic instruments were used to mobilize and transect the lesions.
The LESS liver resection procedure was successfully completed for 10 patients (83.3%), with the remaining 2 patients (16.7%) undergoing conversion to conventional multiport laparoscopy. The procedures consisted of left lateral segment resection (n = 4) and partial resection (n = 8) in addition to concomitant cholecystectomy (n = 3). The mean operative time was 80.4 min (range, 35-160 min), and the mean estimated blood loss was 45 ml (range, 20-800 min). No postoperative complications were noted except for biliary leakage (200 ml/day)in one patient. The mean hospital stay was 4.3 days (range, 2-8 days). No patient required postoperative analgesia, and the pain visual analog score 48 h after surgery was 0.53 (range, 0-2). Pathology identified 10 benign and 2 malignant liver tumors with a clear margin.
Our preliminary data show that LESS liver resection is safe and feasible for selected patients, with potential benefits that include a fast recovery, light pain, and cosmetically acceptable scarring. However, this procedure requires advanced instruments and complicated laparoscopic techniques, with a risk of intraoperative bleeding and postoperative bile leakage.
经脐单孔腹腔镜手术（LESS）是一种新兴的腹腔镜手术，以前用于胆囊切除术和阑尾切除术。然而，很少有研究检查过LESS 肝切除术，其益处需要调查。本研究旨在评估 LESS 肝切除术的可行性和安全性。
在机构审查委员会批准的情况下，从 2009 年 12 月至 2010 年 10 月，选择了 12 名患者进行 LESS 肝切除术。LESS 技术使用经脐三端口或三个 5mm 套管针和一个 5mm 线性或柔性腹腔镜进行。使用常规或铰接式腹腔镜器械来移动和横断病变。
10 名患者（83.3%）成功完成了 LESS 肝切除术，其余 2 名患者（16.7%）转为常规多孔腹腔镜。手术包括左外侧段切除术（n=4）和部分切除术（n=8），以及同时行胆囊切除术（n=3）。手术时间平均为 80.4 分钟（范围 35-160 分钟），估计出血量平均为 45ml（范围 20-800ml）。除了一名患者出现胆漏（200ml/天）外，无术后并发症。平均住院时间为 4.3 天（范围 2-8 天）。无患者需要术后镇痛，术后 48 小时疼痛视觉模拟评分 0.53（范围 0-2）。病理检查发现 10 个良性和 2 个恶性肝肿瘤，边缘清晰。
我们的初步数据表明，LESS 肝切除术对于选定的患者是安全可行的，具有快速恢复、轻度疼痛和美容上可接受的疤痕等潜在益处。然而，该手术需要先进的仪器和复杂的腹腔镜技术，有术中出血和术后胆漏的风险。
