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经皮腹腔镜联合三毫米器械的可行性。

Feasibility of a combined percutaneous laparoscopic three-millimeter device.

作者信息

Bringman Sven, Dalenbäck Jan, Jänes Arthur

机构信息

Department of Surgery, Södertälje Hospital, SE-15286 Södertälje, and CLINTEC, Karolinska Institutet, Stockholm, Sweden.

Department of Surgery, Frölunda Specialist Hospital/Department of Gastrosurgical Research & Education, University of Gothenburg, Västra Frölunda, Sweden.

出版信息

JSLS. 2014 Jan-Mar;18(1):41-5. doi: 10.4293/108680813X13693422520161.

DOI:10.4293/108680813X13693422520161
PMID:24680141
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3939340/
Abstract

BACKGROUND AND OBJECTIVES

Needlescopic 3-mm instruments induce minimal trauma and produce excellent cosmetic results. A combination of a 3-mm abdominal wall incision and a 5-mm instrument in the abdominal cavity would combine the beneficial features of these two different sizes.

METHODS

The Percutaneous Surgical System (PSS) (Ethicon EndoSurgery, Galway, Ireland) is a new instrument consisting of a 3-mm shaft that is introduced percutaneously into the abdominal cavity. Through a 5-mm trocar, a loader with a 5-mm attachment such as a Maryland dissector is introduced. The attachment is connected to the shaft, and the loader is removed from the abdomen. The feasibility of this device was evaluated retrospectively in 3 Swedish hospitals between January and September 2012.

RESULTS

Twenty-eight patients were laparoscopically operated on (cholecystectomy, gastric bypass, fundoplication, incisional hernias, and totally extraperitoneal repair for inguinal hernia) by use of 1 or 2 PSSs in each operation (47 in total). It was feasible to use the PSS in all procedures except during the totally extraperitoneal repair procedure because of the limited available preperitoneal space. Especially in laparoscopic cholecystectomies, the two lateral 5-mm trocars were easily replaced by two 3-mm PSS instruments.

CONCLUSIONS

The use of the PSS is feasible in a number of laparoscopic procedures, where it can replace 5-mm trocars. Randomized controlled trials are needed to determine the future role of the PSS versus, for example, needlescopic laparoscopy.

摘要

背景与目的

3毫米针式腹腔镜器械造成的创伤极小，美容效果极佳。腹壁3毫米切口与腹腔内5毫米器械相结合，可兼具这两种不同尺寸器械的优点。

方法

经皮手术系统（PSS）（爱尔兰戈尔韦的爱惜康内镜外科公司）是一种新型器械，其3毫米的杆部经皮插入腹腔。通过一个5毫米的套管针，将带有5毫米附件（如马里兰解剖器）的加载器插入。附件与杆部相连，然后将加载器从腹部取出。2012年1月至9月期间，在瑞典的3家医院对该装置的可行性进行了回顾性评估。

结果

28例患者接受了腹腔镜手术（胆囊切除术、胃旁路手术、胃底折叠术、切口疝修补术以及腹股沟疝完全腹膜外修补术），每次手术使用1或2个PSS（共47个）。除完全腹膜外修补术因腹膜前空间有限外，在所有手术中使用PSS都是可行的。特别是在腹腔镜胆囊切除术中，两个外侧的5毫米套管针很容易被两个3毫米的PSS器械取代。

结论

PSS在一些腹腔镜手术中是可行的，它可以替代5毫米的套管针。需要进行随机对照试验来确定PSS相对于例如针式腹腔镜检查的未来作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/75ef/3939340/d7692ca87f05/jls0031331090014.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/75ef/3939340/629a5606945b/jls0031331090007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/75ef/3939340/ab329d73f9c7/jls0031331090008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/75ef/3939340/4c48cff495e9/jls0031331090009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/75ef/3939340/d1f542cc2dd5/jls0031331090010.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/75ef/3939340/bda0357ffc47/jls0031331090011.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/75ef/3939340/9777994b0f35/jls0031331090012.jpg
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本文引用的文献

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Needlescopic versus laparoscopic cholecystectomy: a meta-analysis.针式腹腔镜与传统腹腔镜胆囊切除术：一项荟萃分析。
ANZ J Surg. 2009 Jun;79(6):437-42. doi: 10.1111/j.1445-2197.2009.04945.x.
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Needlescopic versus laparoscopic appendectomy: a systematic review.针式腹腔镜与传统腹腔镜阑尾切除术：一项系统评价
Can J Surg. 2009 Apr;52(2):129-34.
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Needlescopic surgery is painless and scarless.
OR Manager. 1997 Nov;13(11):24, 26-7.
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Needle laparoscopy in patients with suspected bowel adhesions.对疑似肠粘连患者进行针式腹腔镜检查。
Obstet Gynecol. 1977 Jan;49(1):105-6.