Morales-Conde Salvador, Rubio-Manzanares Dorado Mercedes, Barranco Antonio, Alarcón Isaías, Pereira José Luis, García-Luna Pedro Pablo, Socas María
Unit of Innovation in Minimally Invasive Surgery, University Hospital Virgen del Rocío, Cardenal Ilundain Street, S/N, 41013, Seville, Spain.
Surg Endosc. 2013 Nov;27(11):4347-53. doi: 10.1007/s00464-013-3070-9. Epub 2013 Jul 12.
The current tendency to use increasingly less aggressive procedures has facilitated the development of new minimally invasive techniques. In this context, single-port (SP) access procedures can become an alternative to the conventional laparoscopic approach.
A total of 22 morbidly obese patients were submitted to pure SP Roux-en-Y gastric bypass without additional ports. Selection for this approach was based on distance from the xiphoid to the umbilicus less than 28 cm, body mass index (BMI) lower than 50 kg/m(2), and preferably peripheral obesity. Access to the cavity was obtained through a single transverse, transumbilical incision, with placement of a SILS Port device.
The mean age of the patients was 41 ± 8.98 years, and 95 % of the patients were women. The mean BMI of the series was 42.68 ± 2.28 kg/m(2), and the mean body weight was 111.34 ± 10.66 kg. Surgery was performed successfully in all cases through a transumbilical incision with a mean length of 26.68 ± 5.27 mm. The mean surgical time was 114.05 ± 21 min, and the mean hospital stay was 3.27 ± 1.01 days. No intraoperative or immediate postoperative deaths or complications occurred. The median postoperative BMI during a mean follow-up period of 12 months was 28 kg/m(2) (range, 18-35 kg/m(2)). The median weight loss was 39 kg, and the percentage loss of excess body weight was 86 %. In relation to improvement of the comorbidities, two of the three patients with arterial hypertension showed normalization of their blood pressure values. Likewise, the blood glucose levels were corrected in two of the three diabetic patients, as well as in the patient with altered fasting blood glucose.
Single-port Roux-en-Y gastric bypass surgery seems to be a safe, viable, and reproducible technique, but randomized studies involving larger patient series and longer follow-up periods are needed to compare the SP access and the multiple-port laparoscopic approach.
当前使用侵袭性越来越小的手术的趋势促进了新的微创技术的发展。在此背景下，单孔（SP）入路手术可成为传统腹腔镜手术方法的替代方案。
共有22例病态肥胖患者接受了单纯SP Roux-en-Y胃旁路手术，未使用额外的端口。选择该手术方法的依据是剑突至脐的距离小于28 cm、体重指数（BMI）低于50 kg/m²，且最好为外周性肥胖。通过单一横向经脐切口进入腹腔，并置入SILS Port装置。
患者的平均年龄为41±8.98岁，95%为女性。该系列患者的平均BMI为42.68±2.28 kg/m²，平均体重为111.34±10.66 kg。所有病例均通过平均长度为26.68±5.27 mm的经脐切口成功完成手术。平均手术时间为114.05±21分钟，平均住院时间为3.27±1.01天。术中或术后即刻未发生死亡或并发症。在平均12个月的随访期内，术后BMI中位数为28 kg/m²（范围为18 - 35 kg/m²）。体重减轻中位数为39 kg，超重体重减轻百分比为86%。关于合并症的改善，3例动脉高血压患者中有2例血压值恢复正常。同样，3例糖尿病患者中有2例以及空腹血糖异常的患者血糖水平得到纠正。
单孔Roux-en-Y胃旁路手术似乎是一种安全、可行且可重复的技术，但需要进行涉及更大患者系列和更长随访期的随机研究，以比较SP入路和多孔腹腔镜手术方法。
