Sales Leonardo Adolpho S, Pinto João Odilo G, Queiroz Carlos Eduardo F, Castro Marcelo, Dourado Paulo Henrique F, Pinheiro Fernando Antonio S
Walter Cantidio University Hospital, Federal University of Ceara, Fortaleza, CE, Brazil.
Arq Bras Cir Dig. 2014 Jan-Mar;27(1):22-5. doi: 10.1590/s0102-67202014000100006.
The minimally invasive abdominal surgery has evolved to reduce portals, culminating with a single incision and natural orifice operation. However, these methods are still expensive, difficult to implement and with questionable aesthetic results.
To present the standardization and preliminary results of a technique for performing laparoscopic suprapubic access by the principle which was called the Supra Pubic Endoscopic Surgery for cholecystectomy.
The average body mass index of patients, the mean operative time, clinical data of the postoperative complications and quality of life were prospectively studied. The operation incisions consisted of: A) umbilical for instrumental dissection and clipping; B) in the right groin for handling and gallbladder gripping; C) suprapubic for the camera. With the patient in reverse Trendelenburg and left lateral decubitus, the operation flew by the camera trocar in C, proceeding with dissection and isolation of the biliary pedicle, identification of cystic duct and artery, with usual instrumentation. Transcystic intraoperative cholangiography was performed in all cases in which there were indications. The procedure was completed with clipping and sectioning of the cystic duct and artery, retrograde resection of the gallbladder and extracting it by the umbilical trocar incision under direct vision.
Thirty patients undergone this surgical procedure between March and June 2012 and were evaluated. The mean age was 40.7 years and the indications were typical biliary colic in 18 cases (60 %), cholecystitis in five cases (16.6 %), biliary pancreatitis in one case (3.3%); polyp in three cases (10%) and obstructive jaundice at three cases (10%). The average body mass index was 27.8 (23.1-35.1) and surgical time ranged between 24 and 70 minutes.
The technique proved to be feasible and safe , with no significant complications, and satisfactory cosmetic results.
微创腹部手术已发展到减少切口数量，最终演变为单切口和经自然腔道手术。然而，这些方法仍然昂贵，难以实施，且美学效果存疑。
介绍一种通过耻骨上内镜手术原理进行腹腔镜耻骨上入路胆囊切除术的技术的标准化及初步结果。
前瞻性研究患者的平均体重指数、平均手术时间、术后并发症的临床数据及生活质量。手术切口包括：A）脐部用于器械分离和夹闭；B）右腹股沟用于操作和夹持胆囊；C）耻骨上用于放置摄像头。患者取头低脚高位并左侧卧位，经C处的摄像头套管进行手术，接着进行胆管蒂的分离和游离，识别胆囊管和动脉，使用常规器械。所有有指征的病例均进行术中经胆囊管胆管造影。手术通过夹闭和切断胆囊管及动脉、逆行切除胆囊并经脐部套管切口在直视下取出胆囊完成。
2012年3月至6月间，30例患者接受了该手术并进行评估。平均年龄为40.7岁，手术指征为典型胆绞痛18例（60%）、胆囊炎5例（16.6%）、胆源性胰腺炎1例（3.3%）、息肉3例（10%）和梗阻性黄疸3例（10%）。平均体重指数为27.8（23.1 - 35.1），手术时间在24至70分钟之间。
该技术被证明是可行且安全的，无明显并发症，且美容效果令人满意。
