Bona S, Molteni M, Montorsi M
Department of General Surgery, IRCCS Istituto Clinico Humanitas, University of Milan School of Medicine, Via Manzoni 56, 20089 Rozzano, Milano, Italy.
Minim Invasive Surg. 2012;2012:482079. doi: 10.1155/2012/482079. Epub 2012 Mar 27.
Laparoscopic colorectal resections have been shown to provide short-term advantages in terms of postoperative pain, general morbidity, recovery, and quality of life. To date, long-term results have been proved to be comparable to open surgery irrefutably only for colon cancer. Recently, new trends keep arising in the direction of minimal invasiveness to reduce surgical trauma after colorectal surgery in order to improve morbidity and cosmetic results. The few reports available in the literature on single-port technique show promising results. Natural orifices endoscopic techniques still have very limited application. We focused our efforts in standardising a minilaparoscopic technique (using 3 to 5 mm instruments) for colorectal resections since it can provide excellent cosmetic results without changing the laparoscopic approach significantly. Thus, there is no need for a new learning curve as minilaparoscopy maintains the principle of instrument triangulation. This determines an undoubted advantage in terms of feasibility and reproducibility of the procedure without increasing operative time. Some preliminary experiences confirm that minilaparoscopic colorectal surgery provides acceptable results, comparable to those reported for laparoscopic surgery with regard to operative time, morbidity, and hospital stay. Randomized controlled studies should be conducted to confirm these early encouraging results.
腹腔镜结直肠切除术已被证明在术后疼痛、总体发病率、恢复情况和生活质量方面具有短期优势。迄今为止,仅在结肠癌方面,长期结果已被无可争议地证明与开放手术相当。最近,为了降低结直肠手术后的手术创伤以改善发病率和美容效果,微创方向不断出现新趋势。文献中关于单孔技术的报道较少,但显示出有前景的结果。自然腔道内镜技术的应用仍然非常有限。我们致力于将一种微型腹腔镜技术(使用3至5毫米器械)标准化用于结直肠切除术,因为它可以在不显著改变腹腔镜手术方式的情况下提供出色的美容效果。因此,由于微型腹腔镜手术保持了器械三角定位的原则,无需新的学习曲线。这在手术的可行性和可重复性方面确定了一个无疑的优势,而不会增加手术时间。一些初步经验证实,微型腹腔镜结直肠手术提供了可接受的结果,在手术时间、发病率和住院时间方面与腹腔镜手术报道的结果相当。应进行随机对照研究以证实这些早期令人鼓舞的结果。