Department of Digestive Surgery, Saku Central Hospital, Saku-City, Nagano, Japan.
Dis Colon Rectum. 2012 Jul;55(7):815-20. doi: 10.1097/DCR.0b013e318252cc68.
In single-access laparoscopic colectomy, the number of instruments that can be inserted through the single-access site is limited by instrument collision. To compensate, triangulation is necessary, but the operative field becomes inadequate. To overcome this problem, intracorporeal attachable and detachable instruments can broaden the field of visceral tissue by retracting from at least 2 points.
We tested this new procedure for colon cancer surgery.
This is a prospective study.
This study was conducted at a single-center hospital.
Ten consecutive patients (3 male and 7 female) with stage II or III colon cancer underwent the procedure.
All patients received a 3.0-cm incision at the umbilicus or right iliac fossa. At least 2 clips and a suspending bar were inserted through a 12-mm port in a multiport access device. The clips grasped the mesocolon at different points and were retracted with either an extracorporeal magnet or fine-loop retractors; this broadened the operative field in the mesocolon by at least 2 points. The mesocolon was dissected with a medial to lateral approach. The suspended bar was tied to 2 fine-loop retractors and manipulated to enlarge the operative field in the mesocolon. The roots of the vascular pedicles were isolated and divided during lymph node dissection. After extracting the specimen, an anastomosis was performed.
Intra- and postoperative complications due to inadequate access were the primary outcomes measured.
There were no intraoperative complications and no need for conversions to open surgery or second access ports. The median total surgical time was 182 minutes (range, 122-245). Surgical blood loss was slight (range, 1-20 mL) in all patients. No postoperative complications occurred. The postoperative hospital stay was 5 to 7 days.
The sample size was small.
This study showed that intracorporeal attachable and detachable instruments were safe and feasible for this procedure.
在单孔腹腔镜结直肠切除术中，由于器械之间的碰撞，可通过单孔插入的器械数量受到限制。为了弥补这一不足，需要采用三角操作法，但这样会导致操作空间不足。为了解决这个问题，可内置、可分离的器械可以通过从至少两个点进行牵拉来扩大内脏组织的操作空间。
我们对这种新的结肠癌手术方法进行了测试。
这是一项前瞻性研究。
这项研究在一家单中心医院进行。
10 例连续的 II 期或 III 期结肠癌患者（3 例男性，7 例女性）接受了该手术。
所有患者均在脐部或右髂窝行 3.0cm 切口。至少 2 个夹子和一个悬吊杆通过多端口接入装置的 12mm 端口插入。夹子夹住横结肠系膜的不同部位，通过体外磁铁或精细环牵开器进行牵拉，这样至少从 2 个点扩大了横结肠系膜的操作空间。采用从中间到外侧的方法进行横结肠系膜解剖。将悬吊杆系在 2 个精细环牵开器上，并进行操作以扩大横结肠系膜的操作空间。游离并分离血管蒂根部，然后进行淋巴结清扫。标本取出后进行吻合。
因操作空间不足导致的术中及术后并发症为主要观察指标。
无术中并发症，无需转为开腹手术或另加操作孔。中位总手术时间为 182 分钟（范围 122245 分钟）。所有患者的手术出血量均较少（120ml）。无术后并发症发生。术后住院时间为 5~7 天。
样本量较小。
本研究表明，内置、可分离的器械用于该手术是安全可行的。
