Department of Surgery, The Methodist Hospital, 6550 Fannin, SM 1661, Houston, TX 77030, USA.
Surg Endosc. 2012 Jan;26(1):149-53. doi: 10.1007/s00464-011-1843-6. Epub 2011 Jul 26.
SSL introduces ergonomic challenges while establishing the critical view during dissection of the Triangle of Calot (TOC). This study investigates the use of a novel percutaneous instrument platform and MAGS in performing SSL cholecystectomy with a technique that closely mimics four-port cholecystectomy.
SSL cholecystectomy was performed on four female cadavers via a 15-18-mm incision made at the umbilicus for introduction of these devices and the working port. MAGS comprises an internal effector with a retractable monopolar cautery hook coupled across the abdominal wall to an external magnet held by the surgeon. The novel grasper was introduced percutaneously in the RUQ and comprises a 3-mm transabdominal shaft mated to a 5-mm end effector intracorporeally. Retraction was accomplished using the percutaneous grasper to manipulate the fundus and a standard 5-mm grasper at the umbilicus for the infundibulum. Dissection was performed by using a combination of the MAGS and a standard Maryland dissector. Total procedure time, time from procedure start to obtain a critical view of the TOC and clipping and dividing the cystic duct/artery, time for dissection of the gallbladder from the liver bed, and thickness of the abdominal wall at the umbilicus were measured.
The critical view was obtained in each case, and all four procedures were completed successfully. Mean procedure time was 40 (range, 33-51) min; time from procedure start to obtaining the critical view and clipping and dividing the cystic duct/artery was 33 (range, 28-38) min, and time for dissection of the gallbladder from the liver bed was 6.7 (range, 3-13) min. The mean abdominal wall thickness was 1.9 (range, 1.5-2) cm.
The use of a novel graspers and MAGS overcomes the limitations of SSL cholecystectomy and improves surgeon dexterity. Making SSL feel more like traditional laparoscopy will enable a wider adoption of this procedure in the community.
在游离胆囊三角（TOC）时，SSL 会带来人机工程学方面的挑战。本研究通过一种接近四孔胆囊切除术的技术，调查了使用新型经皮器械平台和 MAGS 进行 SSL 胆囊切除术的效果。
通过在脐部做一个 15-18mm 的切口，将这些器械和工作端口引入，对 4 具女性尸体进行 SSL 胆囊切除术。MAGS 由一个带有可伸缩单极电烙钩的内部执行器组成，该执行器穿过腹壁与由外科医生持有的外部磁铁相连。新型抓钳经皮引入右肋缘下，由一个 3mm 的经腹轴与一个 5mm 的体内末端执行器相连。通过使用经皮抓钳操纵底部和在脐部使用标准的 5mm 抓钳操纵胆囊漏斗来进行牵引。通过 MAGS 和标准的 Maryland 解剖器的组合来进行解剖。测量总手术时间、从手术开始到获得 TOC 的关键视图并夹闭和切断胆囊管/动脉的时间、从肝床游离胆囊的时间以及脐部腹壁的厚度。
在每种情况下均获得了关键视图，并且所有 4 例手术均成功完成。平均手术时间为 40（范围，33-51）min；从手术开始到获得关键视图并夹闭和切断胆囊管/动脉的时间为 33（范围，28-38）min，从肝床游离胆囊的时间为 6.7（范围，3-13）min。平均腹壁厚度为 1.9（范围，1.5-2）cm。
使用新型抓钳和 MAGS 克服了 SSL 胆囊切除术的局限性，提高了外科医生的灵巧性。使 SSL 更接近传统腹腔镜手术，将使该手术在社区得到更广泛的应用。
