University Hospital of North Tees, Hardwick, Stockton-on-Tees, UK.
Dis Colon Rectum. 2011 Aug;54(8):1053-6. doi: 10.1097/DCR.0b013e318221aa13.
Single-port access offers cosmetic advantages in addition to the well-recognized benefits of standard multiport laparoscopic surgery, and can be performed with the use of standard straight instruments. We describe a technique of single-port access reversal of Hartmann colostomy by use of the colostomy site for access.
After routine skin preparation and laparoscopic setup, the colostomy is mobilized from its mucocutaneous border, and the anvil of a circular stapler is secured to the distal lumen. By the use of a GelPoint system with 3 or 4 trocars, the intra-abdominal adhesions are divided and the splenic flexure is mobilized to achieve sufficient access to the abdominal and pelvic cavities and proximal colonic mobility. The rectal stump is mobilized to the mid rectum, starting from the posterior mesorectal fascia around to the anterior rectal wall. A tension-free colorectal anastomosis is secured with a standard circular stapling device inserted transanally, and leak tested. The colostomy wound is closed in standard fashion.
Five patients underwent single-port access reversal of Hartmann resection (4 diverticular perforations and 1 pT3N0 colon cancer), with a mean operating time of 155 (range, 137-187) minutes and a median length of stay of 3 (range, 2-11) days. There were no conversions, major surgical morbidity, or deaths.
Single-port access reversal of Hartmann colostomy through the stoma site is safe, and it offers additional cosmetic advantages with no apparent additional morbidity in comparison with standard multiport surgery.
单孔通道除了具有标准多孔腹腔镜手术的公认优势外，还具有美容优势，并且可以使用标准的直器械进行操作。我们描述了一种通过造口部位进行单孔通道反转Hartmann 结肠造口术的技术。
在常规皮肤准备和腹腔镜设置后，从其黏膜皮肤边界游离结肠造口，并将圆形吻合器的吻合器头固定到远端管腔。通过使用带有 3 或 4 个 trocar 的 GelPoint 系统，分离腹腔内粘连并游离脾曲，以获得足够的腹部和盆腔以及近端结肠活动性。将直肠残端游离到中直肠，从前直肠壁周围的后直肠系膜筋膜开始。通过经肛门插入标准的圆形吻合器，确保无张力的结直肠吻合，并进行渗漏测试。以标准方式闭合结肠造口伤口。
5 例患者接受了单孔通道反转 Hartmann 切除术（4 例憩室穿孔和 1 例 pT3N0 结肠癌），平均手术时间为 155 分钟（范围为 137-187 分钟），中位住院时间为 3 天（范围为 2-11 天）。没有转换，没有重大手术并发症或死亡。
通过造口部位进行单孔通道反转 Hartmann 结肠造口术是安全的，与标准多孔手术相比，它具有额外的美容优势，并且没有明显的额外发病率。
