Sumiyoshi Kinjiro, Sato Norihiro, Akagawa Shin, Hirano Tatsuya, Koikawa Kazuhiro, Horioka Kohei, Ozono Keigo, Fujiwara Kenji, Tanaka Masao, Sada Masayuki
Department of Surgery, Fukuoka Red Cross hospital, Fukuoka, Japan.
Hepatogastroenterology. 2012 Mar-Apr;59(114):325-8. doi: 10.5754/hge11125.
BACKGROUND/AIMS: Single-incision laparoscopic cholecystectomy (SILC) is a promising alternative to standard multi-incision laparoscopic cholecystectomy (LC). However, generalization of SILC is still hampered by technical difficulties mainly associated with the lack of trocars used for retraction of the gallbladder. We therefore developed a modified method of SILC with the use of needle graspers (SILC-N) for optimal retraction and exposure.
In addition to two trocars inserted through a single transumbilical incision, two needle ports were placed on the right subcostal and lateral abdominal wall, through which needle graspers were used for retraction of the gallbladder. Since December, 2009, 12 patients with symptomatic cholelithiasis were treated by SILC-N.
SILC-N was successfully performed in all but one patient requiring a conversion to the 4-port LC with a mean operative time of 71.5 (48-107) minutes. None of the patients experienced intraoperative or postoperative complications. The transumbilical incision and pinholes for needle graspers were almost invisible on discharge.
Our preliminary results suggest that SILC-N is a simple, safe and feasible technique of cholecystectomy offering similar postoperative recovery and better cosmetic outcome as compared to conventional LC.
背景/目的：单孔腹腔镜胆囊切除术（SILC）是标准多孔腹腔镜胆囊切除术（LC）一种有前景的替代方法。然而，SILC的推广仍然受到技术难题的阻碍，这些难题主要与缺乏用于牵拉胆囊的套管针有关。因此，我们开发了一种改良的SILC方法，使用针抓钳（SILC-N）以实现最佳的牵拉和暴露。
除了通过单一脐部切口插入的两个套管针外，在右肋缘下和侧腹壁放置两个针孔，通过这些针孔使用针抓钳牵拉胆囊。自2009年12月以来，12例有症状的胆石症患者接受了SILC-N治疗。
除1例患者需要转为四孔LC外，其余患者均成功实施了SILC-N，平均手术时间为71.5（48 - 107）分钟。所有患者均未发生术中或术后并发症。出院时脐部切口和针抓钳的针孔几乎不可见。
我们的初步结果表明，SILC-N是一种简单、安全且可行的胆囊切除技术，与传统LC相比，术后恢复相似且美容效果更好。
