Shibao Kazunori, Takagi Tsuyoshi, Higure Aiichiro, Yamaguchi Koji
Department of Surgery I School of Medicine University of Occupational and Environmental Health Kitakyushu, Japan.
Department of Surgery Nishijin Hospital Kyoto, Japan.
Surg Technol Int. 2013 Sep;23:75-9.
We recently developed an oval-shaped E•Z Access device designed exclusively for use with the LAP PROTECTOR™ Oval type device (Hakko Co. Ltd., Tokyo, Japan). The transverse abdominal opening diameter made by round-shaped (Alexis® Wound Retractor, Applied Medical, Rancho Santa Margarita, CA; and LAP PROTECTOR™ Round type) and oval-shaped (LAP PROTECTOR™ Oval type) wound retractors was measured and compared in 5 patients with cholecystolithiasis. Each device was placed through a single 25-mm longitudinal umbilical incision, and the length of trocar separation was compared. LESS cholecystectomy was then performed using the oval-shaped E•Z ACCESS/LAP PROTECTOR™. The transverse abdominal opening diameter was maximized with the LAP PROTECTOR™ Oval type device. The average distance between the working-ports for the glove method, round-shaped, and oval-shaped E•Z ACCESS/LAP PROTECTOR™ devices in the 25-mm umbilical incisions were 20 ± 0.8 mm, 24 ± 1.5 mm, and 35 ± 0.8 mm, respectively. Wider trocar separation was achieved using the oval-shaped device, making the surgical procedures easier to perform. No perioperative port-related or surgical complications were observed. LESS cholecystectomy using the E•Z ACCESS Oval type device was found to be technically feasible. The Oval type device appears to allow for wider trocar separation, thereby reducing stress on the surgeon, ensuring patient safety, and providing cosmetic benefits.
我们最近开发了一种椭圆形的E•Z Access装置,专门设计用于与LAP PROTECTOR™椭圆形装置(日本东京哈科有限公司)配合使用。在5例胆囊结石患者中,测量并比较了圆形(Alexis®伤口牵开器,应用医疗公司,加利福尼亚州兰乔圣玛格丽塔;以及LAP PROTECTOR™圆形)和椭圆形(LAP PROTECTOR™椭圆形)伤口牵开器所形成的腹部横向开口直径。每个装置均通过一个25毫米的纵向脐部切口置入,并比较套管针分离的长度。然后使用椭圆形E•Z ACCESS/LAP PROTECTOR™进行LESS胆囊切除术。LAP PROTECTOR™椭圆形装置可使腹部横向开口直径最大化。在25毫米脐部切口中,手套法、圆形和椭圆形E•Z ACCESS/LAP PROTECTOR™装置的工作端口之间的平均距离分别为20±0.8毫米、24±1.5毫米和35±0.8毫米。使用椭圆形装置可实现更宽的套管针分离,使手术操作更易于进行。未观察到围手术期与端口相关的或手术并发症。发现使用E•Z ACCESS椭圆形装置进行LESS胆囊切除术在技术上是可行的。椭圆形装置似乎可实现更宽的套管针分离,从而减轻外科医生的压力,确保患者安全,并具有美容效果。