Shibao Kazunori, Higure Aiichiro, Yamaguchi Koji, Minagawa Noritaka
Assistant Professor, Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Professor, Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Surg Technol Int. 2011 Dec;21:101-5.
Reduced port surgery (RPS) is a new surgical modality producing increased cosmetic benefits over conventional endoscopic surgery. We herein report the first case of insulinoma of the pancreas treated by RPS. RPS enucleation was performed for a 23-year-old Japanese female who was admitted to our hospital with repeated episodes of hypoglycemia attributable to an insulinoma. The preoperative examinations confirmed the diagnosis of a solitary insulinoma of the pancreatic tail. Enucleation of the insulinoma using RPS was performed. A 2.5-cm umbilical incision was made, and three laparoscopic trocars were individually inserted into the abdominal cavity via this incision. Another 3-mm trocar was inserted from the left subcostal region. All procedures that were usually performed in conventional laparoscopic surgery were also performed by RPS: intraoperative ultrasonography, mobilization of the tail of the pancreas, enucleation of the tumor, and suturing of the stump. A mechanical manipulator, the Radius Surgical System (Radius), was used for suturing and ligation. The Radius was sufficient to overcome in-line viewing and hand/instrument collisions, and enabled us to perform precise suturing and ligation. Serial blood sugar, C-peptide immunoreactivity (CPR), and immunoreactive insulin (IRI) measurements revealed that all values were normal after resection. The patient had an uneventful postoperative course. RPS was successfully applied for enucleation of a solitary mass in the tail of the pancreas, and represents an alternative to conventional laparoscopic surgery. This method is technically feasible and results in superior cosmesis. The Radius facilitated advanced laparoscopic surgery and may also have advantages in RPS.
缩小切口手术（RPS）是一种新的手术方式，与传统的内镜手术相比，它能带来更多的美容益处。我们在此报告首例采用RPS治疗的胰腺胰岛素瘤病例。对一名23岁的日本女性进行了RPS摘除术，该患者因胰岛素瘤导致反复低血糖发作而入住我院。术前检查确诊为胰尾单发胰岛素瘤。采用RPS进行胰岛素瘤摘除术。做了一个2.5厘米的脐部切口，通过该切口将三个腹腔镜套管针分别插入腹腔。从左肋下区域插入另一个3毫米的套管针。通常在传统腹腔镜手术中进行的所有操作，RPS也都进行了：术中超声检查、胰腺尾部游离、肿瘤摘除以及残端缝合。使用了一种机械操作器，即Radius手术系统（Radius）进行缝合和结扎。Radius足以克服直视和手/器械碰撞问题，使我们能够进行精确的缝合和结扎。连续测量血糖、C肽免疫反应性（CPR）和免疫反应性胰岛素（IRI）显示，切除后所有值均正常。患者术后恢复顺利。RPS成功应用于胰尾单发肿块的摘除，是传统腹腔镜手术的一种替代方法。该方法在技术上可行，且美容效果更佳。Radius有助于进行先进的腹腔镜手术，在RPS中可能也具有优势。
