Idani Hitoshi, Nakano Kanyu, Asami Shinya, Kubota Tetsushi, Komoto Satoshi, Kurose Yohei, Kubo Shinichiro, Nojima Hiroki, Hioki Katsuyoshi, Kin Hitoshi, Takakura Norihisa
Department of Surgery, Fukuyama City Hospital, Fukuyama, Hiroshima 721-8511, Japan.
Acta Med Okayama. 2013;67(4):259-63. doi: 10.18926/AMO/51071.
We describe a new simple and easy technique called the "Hook and roll technique" (HRT) that uses an articulating hook cautery to provide a critical view during single incision laparoscopic cholecystectomy (SILC). A 2-cm incision is made at the umbilicus to insert three 5-mm trocars or a multichannel port. After dissection of the serosa of the dorsal and ventral sides of the gall bladder, including Calot's triangle, the angled tip of the hook cautery is inserted between the cystic artery and duct with its tip placed dorsally. The tip is then rotated in a clockwise manner to avoid bile duct injury, allowing the connective tissue between them to be hooked, coagulated and cut. This procedure is repeated several times, followed by dissection between the cystic artery and the liver bed to achieve a critical view. From December 2008 to May 2011, 121 patients underwent SILC using HRT in our hospital without any serious complications. This technique is suitable for SILC, as it is consists of simple procedures that can be performed safely and easily, even by left hand in a cross-over approach, and it allows complete dissection of Calot's triangle to achieve a critical view without using any dissector under dangerous in-line viewing.
我们描述了一种名为“钩转技术”（HRT）的新的简单易行的技术，该技术在单孔腹腔镜胆囊切除术（SILC）中使用关节式钩形电灼器以提供关键视野。在脐部做一个2厘米的切口，插入三个5毫米的套管针或一个多通道端口。在解剖胆囊背侧和腹侧的浆膜，包括胆囊三角后，将钩形电灼器的成角尖端插入胆囊动脉和胆囊管之间，尖端背侧放置。然后将尖端顺时针旋转以避免胆管损伤，使它们之间的结缔组织被钩住、凝固并切断。重复此过程几次，然后在胆囊动脉和肝床之间进行解剖以获得关键视野。2008年12月至2011年5月，我院121例患者使用HRT进行了SILC，无任何严重并发症。该技术适用于SILC，因为它由简单的操作组成，即使采用交叉入路用左手也能安全、轻松地进行，并且它允许在危险的直线视野下不使用任何分离器就完全解剖胆囊三角以获得关键视野。
