Clark C E, Liasis L, Papaconstantinou H T
Department of Surgery, Texas A&M University System Health Science Center College of Medicine, TX, USA.
Minerva Chir. 2012 Apr;67(2):111-26.
Laparoscopic colorectal surgery has advantages over open surgery including shorter postoperative length of hospital stay, early return of bowel function, decreased complications and reduced postoperative pain. Innovative minimally invasive surgery techniques such as single-incision laparoscopic surgery (SIL) have emerged to further enhance outcomes of conventional laparoscopy. This technique uses a single small incision for access of all instruments and specimen extraction. This concept has been proposed to improve cosmesis and enhance recovery. Technological advances have been introduced to overcome the challenges of co-axial instrument movement and collision that is inherent to SIL surgery. The application of SIL techniques to colorectal surgery is in its infancy, but gaining significant momentum. Early case reports and series have shown feasibility and safety. Emerging comparative studies of SIL colectomy to standard laparoscopic techniques are providing evidence of equivalency with potential benefit in outcomes such as reduced early postoperative pain and shortened length of hospital stay. The application of the SIL platform to robotics and transanal surgery demonstrates the broadening scope of this innovative field. However, we must be cognizant of the impact on surgeon training and resident education. In this review we present the current evidence supporting the application of SIL to colorectal surgery.
腹腔镜结直肠手术相对于开放手术具有诸多优势，包括术后住院时间缩短、肠功能早期恢复、并发症减少以及术后疼痛减轻。诸如单孔腹腔镜手术（SIL）等创新的微创手术技术已经出现，以进一步改善传统腹腔镜手术的效果。该技术通过一个小切口来置入所有器械并取出标本。提出这一概念是为了改善美观效果并促进恢复。已引入技术进步来克服SIL手术固有的同轴器械移动和碰撞挑战。SIL技术在结直肠手术中的应用尚处于起步阶段，但正获得显著发展势头。早期的病例报告和系列研究已显示出其可行性和安全性。SIL结肠切除术与标准腹腔镜技术的新兴对比研究正在提供等效性证据，在诸如减轻术后早期疼痛和缩短住院时间等结果方面可能具有益处。SIL平台在机器人手术和经肛门手术中的应用表明了这一创新领域的范围正在不断扩大。然而，我们必须认识到其对外科医生培训和住院医师教育的影响。在本综述中，我们展示了支持SIL应用于结直肠手术的当前证据。
