Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Dis Colon Rectum. 2012 Feb;55(2):134-9. doi: 10.1097/DCR.0b013e31823c0ae4.
Single-port laparoscopy remains a novel technique in the field of colorectal surgery. Several small series have examined its safety for colon resection.
Our aim was to analyze our entire experience and short-term outcomes with single-port laparoscopic right hemicolectomy since its introduction at our institution. We assert that this approach is feasible and safe for the wide array of patients and indications encountered by a colorectal surgeon.
This is a retrospective analysis of prospectively gathered data for all patients who underwent single-port laparoscopic right hemicolectomy with the use of standard laparoscopic instrumentation, for malignant or benign disease, between July 2009 and November 2010 in a high-volume, academic, colorectal surgery practice.
Demographic, clinical, operative, and pathologic factors were reviewed and analyzed. All conversions to conventional laparoscopic or open operations were considered in this analysis.
One hundred patients underwent single-port laparoscopic right hemicolectomy during the study period. Mean age was 63 years, and 61% of the patients were men. Forty-three percent had undergone previous abdominal surgery, and the median body mass index was 26 (range, 18-46). Median ASA classification was 3 (range, 1-4). Five percent of the operations were performed urgently, and 56% were performed for carcinoma, of which half were T3 or T4 tumor stage. Median operative duration was 105 (range, 64-270) minutes. Mean and median blood loss was 106 and 50 mL. Two percent required conversion to multiport laparoscopy, and 4% converted to the open approach. Median postoperative stay was 4 (range, 2-48) days. Median lymph node number was 18 (range, 11-42). There was one mortality in this series. Morbidity, including wound infection, was 13%.
This represents the largest experience with single-port laparoscopic right hemicolectomy to date. This technique was used with acceptable morbidity and mortality and without compromise of conventional oncologic parameters by colorectal surgeons experienced in minimally invasive technique. These findings support the use of a single-port approach for patients requiring right hemicolectomy.
单孔腹腔镜仍然是结直肠外科领域的一项新技术。有几个小系列研究检查了其用于结肠切除术的安全性。
我们旨在分析自我院开展以来，单孔腹腔镜右半结肠切除术的全部经验和短期结果。我们认为，对于结直肠外科医生遇到的广泛的患者和适应证，这种方法是可行且安全的。
这是对 2009 年 7 月至 2010 年 11 月期间，在一家高容量的学术性结直肠外科手术实践中，使用标准腹腔镜器械对因恶性或良性疾病而接受单孔腹腔镜右半结肠切除术的所有患者的前瞻性采集数据进行的回顾性分析。
回顾和分析了人口统计学、临床、手术和病理因素。所有转换为常规腹腔镜或开放手术的情况均包括在本分析中。
研究期间共有 100 例患者接受了单孔腹腔镜右半结肠切除术。平均年龄为 63 岁，61%的患者为男性。43%的患者曾接受过腹部手术，中位数体重指数为 26（范围 18-46）。中位数美国麻醉师协会（ASA）分级为 3 级（范围 1-4 级）。5%的手术为紧急手术，56%的手术为癌，其中一半为 T3 或 T4 肿瘤分期。中位手术时间为 105 分钟（范围 64-270 分钟）。平均和中位数出血量分别为 106 和 50 毫升。2%的患者需要转换为多孔腹腔镜，4%的患者转为开放手术。中位术后住院时间为 4 天（范围 2-48 天）。中位数淋巴结数量为 18 个（范围 11-42 个）。本系列中有 1 例死亡。包括伤口感染在内的发病率为 13%。
这是目前为止关于单孔腹腔镜右半结肠切除术的最大经验总结。该技术由经验丰富的微创技术结直肠外科医生使用，具有可接受的发病率和死亡率，并且不会影响常规肿瘤学参数。这些发现支持为需要右半结肠切除术的患者使用单孔方法。
