Jurczak Florent, Pousset Jean-Paul
Department of General Surgery, Polyclinique de l'Océan, 38 rue de Pornichet, 44600 Saint Nazaire, France.
Minim Invasive Surg. 2010;2010:582763. doi: 10.1155/2010/582763. Epub 2010 Jan 28.
Background. The laparoscopic cholecystectomy is a perfectly codified surgical procedure. The development of recent innovative and experimental surgical techniques Natural Orifice transluminal endoscopic surger (N.O.T.E.S.) which reduces the abdominal wall trauma leads us to develop a combined procedure of a standard dissection using miniaturised instruments already existing on the market (3 and 5 mm wide) and a gall bladder removal through a short gastrotomy Natural Orifice Specimen Extraction (N.O.S.E.). Methods. Our objective was to evaluate the safety, the feasibility, and the reproducibility of our new approach. After reviewing existing products on the market and a feasibility study, we put in place a protocol in our structure for patients on whom the procedure was performed. We carried out a gall bladder removal by a short gastrotomy, located on the anterior gastric wall, which then reduced the abdominal wall trauma and allowed them to resume normal physical activity quickly without risk of trocar site hernia. Results. We performed the procedure described in this paper on 63 patients, between April 2008 and July 2009. There were 14 men and 49 women with an average age of 46.8 years (ranging from 28 to 77) and an average BMI of 27.2. 30 patients had at least one gallstone larger than 10 mm. There was no postoperative gastric or abdominal wall complication and a fast recovery for all the patients in our study. Conclusions. This procedure is feasible, reproducible, with good results and minimal abdominal wall trauma. It is also safer than N.O.T.E.S. and endoscopic clipping and recovery, allowing normal physical activity, fast and, without risk of incisional hernia.
背景。腹腔镜胆囊切除术是一种已被完美编订的外科手术。近期创新和实验性外科技术——经自然腔道内镜手术（NOTES）的发展减少了腹壁创伤，这促使我们开发一种联合手术，即使用市场上已有的小型化器械（3毫米和5毫米宽）进行标准解剖，并通过短胃切开术经自然腔道取出标本（NOSE）来切除胆囊。方法。我们的目的是评估我们新方法的安全性、可行性和可重复性。在审查了市场上现有的产品并进行可行性研究后，我们在我们的机构中为接受该手术的患者制定了一个方案。我们通过位于胃前壁的短胃切开术进行胆囊切除，这减少了腹壁创伤，并使患者能够迅速恢复正常体力活动，而没有套管针穿刺部位疝的风险。结果。在2008年4月至2009年7月期间，我们对63例患者实施了本文所述的手术。其中男性14例，女性49例，平均年龄46.8岁（范围为28至77岁），平均体重指数为27.2。30例患者至少有一颗直径大于10毫米的胆结石。我们研究中的所有患者均未出现术后胃部或腹壁并发症，且恢复迅速。结论。该手术可行、可重复，效果良好，腹壁创伤最小。它也比NOTES以及内镜夹闭和恢复更安全，能让患者进行正常体力活动，恢复快，且没有切口疝的风险。
