Arru Luca, Azagra Juan Santiago, Goergen Martine, de Blasi Vito, de Magistris Luigi, Facy Olivier
Department of Surgery, U.M.A.D.E. and U.P.O, Universitary Hospital Center of Luxembourg Luxembourg, Luxembourg.
Cir Esp. 2013 May;91(5):294-300. doi: 10.1016/j.ciresp.2012.10.003. Epub 2013 Mar 8.
The aim of this paper is to propose our technique, namely three-port laparoscopic sleeve gastrectomy (TPLSG), to define the feasibility and expose the short-outcomes, as an alternative between the standard laparoscopic approach and the single incision (SILSG) for such patients.
We conducted a prospective study of 25 patients: 12 male and 13 female, reporting a mean BMI of 53 kg/m² (range: 50-72) and a mean age of 38 years (range: 29-55). To evaluate the feasibility of our technique we have always respecting 3 pre-operatives conditions: BMI ≥ 50 kg/m². Preoperative abdominal US or CT to measure the liver and determine the hepato-splenic characteristics. "Intent to treat by 3 ports" (2 of 5 mm and one 12 mm in diameter). The short outcomes follow-up include: operative time, conversion, transfusions, fistula, reinterventions and parietal herniation at one and three months after surgery.
Hepatomegaly was present in 19 (76%) patients, and it's greater on the left hepatic lobe in 9 (36%) patients. The mean operation time was 72 min (range: 50-110). No per-operative complications were observed. Conversion to four ports procedure was necessary in one patient. The mean hospital stay was 3 days (range: 2-5). No mortality and 30th POD morbidity rate was reported. No patient developed an incisional hernia to date.
The TPLSG reduces the ports in number and in size and subsequently the parietal trauma, it also an instrumental triangulation, making surgery safe and reproducible.
本文旨在介绍我们的技术，即三孔腹腔镜袖状胃切除术（TPLSG），以确定其可行性并揭示短期疗效，作为此类患者标准腹腔镜手术方法和单切口腹腔镜袖状胃切除术（SILSG）之间的一种替代方案。
我们对25例患者进行了前瞻性研究，其中男性12例，女性13例，平均体重指数（BMI）为53kg/m²（范围：50-72），平均年龄38岁（范围：29-55）。为评估我们技术的可行性，我们始终遵循3个术前条件：BMI≥50kg/m²；术前行腹部超声或CT检查以测量肝脏并确定肝脾特征；“采用三孔进行治疗”（2个直径5mm的孔和1个直径12mm的孔）。短期疗效随访包括：手术时间、中转手术、输血、瘘、再次干预以及术后1个月和3个月时的腹壁疝。
19例（76%）患者存在肝肿大，其中9例（36%）患者左肝叶肿大更明显。平均手术时间为72分钟（范围：50-110）。未观察到术中并发症。1例患者需要中转至四孔手术。平均住院时间为3天（范围：2-5）。未报告死亡病例及术后30天的发病率。迄今为止，无患者发生切口疝。
TPLSG减少了端口数量和尺寸，进而减少了腹壁创伤，它也是一种器械三角定位法，使手术安全且可重复进行。
