Seifarth Federico G, Ramirez José R, Magnuson David K
Cleveland Clinic Foundation, Department of Pediatric Surgery, Pediatric Institute & Children's Hospital, Cleveland, OH 44195, USA.
JSLS. 2012 Jul-Sep;16(3):401-5. doi: 10.4293/108680812X13427982377148.
Multiple single-port or single-incision techniques have been successfully implemented for laparoscopic cholecystectomy in adults and children. These techniques require either a large multichannel port or a larger skin incision to accommodate multiple ports or instruments. Inspired by a first generation single-port instrument, we developed a safe and effective technique for a single-port laparoscopic cholecystectomy with virtually scarless results.
Over a 14-mo period, 20 patients (19 females, 1 male) underwent the hybrid single-port cholecystectomy. A straight 10-mm Storz telescope with inbuilt 6-mm working channel in combination with 2 portless 2.3-mm percutaneous graspers was used. The dissection is carried out with 43-cm bariatric length instruments. The cystic artery and duct are sealed with WECK Hem-o-lok clips or the Harmonic scalpel.
Range (mean) age: 7.7 y to 19.5 y (15.5), BMI: 11.6kg/m(2) to 42.3kg/m(2) (27), operative duration 48 min to 120 min (79), postoperative length of stay: 5 h to 78 h (24).
13 patients cholecystolithiasis, 7 patients biliary dyskinesia. Conversion to conventional 4-port cholecystectomy was required in 2 patients. No intra- or postoperative complications occurred.
The hybrid single-port technique is easy to master. It provides traditional anatomical exposure and allows application of conventional laparoscopic principles.
多种单孔或单切口技术已成功应用于成人及儿童的腹腔镜胆囊切除术。这些技术需要一个大型多通道端口或更大的皮肤切口来容纳多个端口或器械。受第一代单孔器械的启发，我们开发了一种安全有效的单孔腹腔镜胆囊切除术技术，几乎不留疤痕。
在14个月的时间里，20例患者（19例女性，1例男性）接受了混合单孔胆囊切除术。使用了一台内置6毫米工作通道的10毫米直形史托斯望远镜，以及2把无端口的2.3毫米经皮抓钳。使用43厘米长的减重手术器械进行解剖。胆囊动脉和胆囊管用威克Hem-o-lok夹或超声刀封闭。
年龄范围（平均）：7.7岁至19.5岁（15.5岁），体重指数：11.6kg/m²至42.3kg/m²（27），手术时间48分钟至120分钟（79分钟），术后住院时间：5小时至78小时（24小时）。
13例胆囊结石，7例胆囊运动障碍。2例患者需要转为传统的四孔胆囊切除术。未发生术中或术后并发症。
混合单孔技术易于掌握。它提供了传统的解剖暴露，并允许应用传统的腹腔镜原则。
