Hopping Jacob R, Bardakcioglu Ovunc
Department of Surgery, Saint Louis University, St Louis, MO, USA.
JSLS. 2013 Apr-Jun;17(2):194-7. doi: 10.4293/108680813X13654754534558.
Single-port laparoscopic colectomy is described as a new technique in colorectal surgery. The initial case reports show the safety and feasibility, but the learning curve for this technique is unknown.
Between July 2009 and September 2010, 20 consecutive patients with an indication for right hemicolectomy underwent a single-port laparoscopic approach without bias in selection. The only exclusion criterion was a prior midline laparotomy. The patients were followed up for 30 days. Chart review was completed for up to 35 months to assess long-term morbidity and mortality rates.
The median age was 65 years (range, 59-88 years). Ninety percent of patients were men. The median body mass index was 28 kg/m(2) (range, 20-35 kg/m(2)). Seventy-five percent of patients had significant comorbidities with an American Society of Anesthesiologists class of 3 or 4. The estimated blood loss was 25 mL (range, 25-250 mL). The median number of pathologic lymph nodes for patients diagnosed with adenocarcinoma was 16 (range, 8-23). There was one conversion to hand-assisted laparoscopic (case 6) and one to open colectomy (case 9) because of the inability to achieve safe vessel ligation. The median hospital stay was 4.5 days (range, 3-7 days). The length of stay for the first 10 patients was 5.1 days, and it was 3.9 days for the last 10 patients (P = .045). There were no significant postoperative complications within 30 days. The mean operative time for the first 10 cases was 198 minutes (range, 148-272 minutes), and it was 123 minutes (range, 98-150 minutes) for the subsequent 10 cases (P = .0001). All intraoperative complications (minor bleeding) occurred within the first 10 patients, with no significant bleeding recorded for the last 10 cases.
Single-port laparoscopic right hemicolectomy can be safely performed in patients who are candidates for conventional or hand-assisted right hemicolectomy with very low intraoperative and postoperative complication rates. The 30-day morbidity rate remained low with this technique. The higher technical difficulty compared with conventional laparoscopy is reflected in the longer initial operative times. The learning curve for a surgeon with advanced laparoscopic skills and adequate procedure numbers seems to be short, requiring approximately 10 cases to decrease operative times to baseline. The role and feasibility of broad adaptation for single-incision laparoscopy in colorectal surgery need to be further evaluated in larger case series and trials.
单孔腹腔镜结肠切除术被视为结直肠手术中的一项新技术。最初的病例报告显示了其安全性和可行性，但该技术的学习曲线尚不清楚。
在2009年7月至2010年9月期间，20例有右半结肠切除术指征的患者连续接受了单孔腹腔镜手术，选择过程中无偏倚。唯一的排除标准是既往有中线剖腹手术史。对患者进行了30天的随访。完成病历审查长达35个月，以评估长期发病率和死亡率。
中位年龄为65岁（范围59 - 88岁）。90%的患者为男性。中位体重指数为28 kg/m²（范围20 - 35 kg/m²）。75% 的患者有显著合并症，美国麻醉医师协会分级为3或4级。估计失血量为25 mL（范围2D - 250 mL）。诊断为腺癌的患者病理淋巴结中位数为16个（范围8 - 23个）。因无法安全结扎血管，有1例转为手辅助腹腔镜手术（病例6），1例转为开放结肠切除术（病例9）。中位住院时间为4.5天（范围3 - 7天）。前10例患者的住院时间为5.1天，后10例患者为3.9天（P = 0.045）。30天内无显著术后并发症发生。前10例手术的平均手术时间为198分钟（范围148 - 272分钟），后10例为123分钟（范围98 - 150分钟）（P = 0.0001）。所有术中并发症（轻微出血）均发生在前10例患者中，后10例未记录到显著出血。
单孔腹腔镜右半结肠切除术可安全地应用于适合传统或手辅助右半结肠切除术的患者，术中及术后并发症发生率极低。该技术30天发病率仍较低。与传统腹腔镜手术相比，技术难度较高体现在初始手术时间较长。对于具备先进腹腔镜技术且手术例数充足的外科医生，学习曲线似乎较短，大约需要10例手术即可将手术时间降至基线水平。单切口腹腔镜手术在结直肠手术中广泛应用的作用和可行性需要在更大规模的病例系列和试验中进一步评估。
