Cianchi Fabio, Staderini Fabio, Badii Benedetta
Fabio Cianchi, Fabio Staderini, Benedetta Badii, Department of Surgery and Translational Medicine, Center of Oncological Minimally Invasive Surgery, University of Florence, 50134 Florence, Italy.
World J Gastroenterol. 2014 May 28;20(20):6073-80. doi: 10.3748/wjg.v20.i20.6073.
A number of clinical trials have demonstrated that the laparoscopic approach for colorectal cancer resection provides the same oncologic results as open surgery along with all clinical benefits of minimally invasive surgery. During the last years, a great effort has been made to research for minimizing parietal trauma, yet for cosmetic reasons and in order to further reduce surgery-related pain and morbidity. New techniques, such as natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopy (SIL) have been developed in order to reach the goal of "scarless" surgery. Although NOTES may seem not fully suitable or safe for advanced procedures, such as colectomies, SIL is currently regarded as the next major advance in the progress of minimally invasive surgical approaches to colorectal disease that is more feasible in generalized use. The small incision through the umbilicus allows surgeons to use familiar standard laparoscopic instruments and thus, perform even complex procedures which require extraction of large surgical specimens or intestinal anastomosis. The cosmetic result from SIL is also better because the only incision is made through the umbilicus which can hide the wound effectively after operation. However, SIL raises a number of specific new challenges compared with the laparoscopic conventional approach. A reduced capacity for triangulation, the repeated conflicts between the shafts of the instruments and the difficulties to achieve a correct exposure of the operative field are the most claimed issues. The use therefore of this new approach for complex colorectal procedures might understandingly be viewed as difficult to implement, especially for oncologic cases.
多项临床试验表明，腹腔镜结直肠癌切除术与开放手术具有相同的肿瘤学疗效，同时具备微创手术的所有临床优势。在过去几年中，人们付出了巨大努力来研究如何将腹壁创伤降至最低，这既是出于美观考虑，也是为了进一步减轻手术相关的疼痛和发病率。为了实现“无疤痕”手术的目标，已经开发了诸如经自然腔道内镜手术（NOTES）和单切口腹腔镜手术（SIL）等新技术。尽管NOTES对于诸如结肠切除术等复杂手术可能看起来并不完全合适或安全，但SIL目前被视为结直肠疾病微创外科手术进展中的下一个重大突破，在广泛应用中更可行。通过脐部的小切口使外科医生能够使用熟悉的标准腹腔镜器械，从而能够进行甚至是需要取出大手术标本或进行肠吻合的复杂手术。SIL的美容效果也更好，因为唯一的切口是通过脐部进行的，术后能够有效隐藏伤口。然而，与传统腹腔镜手术方法相比，SIL带来了一些新的特定挑战。三角定位能力降低、器械杆之间反复出现冲突以及难以正确暴露手术视野是最常被提及的问题。因此，将这种新方法用于复杂的结直肠手术可能理所当然地被认为难以实施，尤其是对于肿瘤病例。
