Kawahara Hidejiro, Watanabe Kazuhiro, Tomoda Mitsuhiro, Enomoto Hiroya, Akiba Tadashi, Yanaga Katsuhiko
Hepatogastroenterology. 2014 Mar-Apr;61(130):453-5.
Although single incision laparoscopy surgery (SILS) has been applied to various kinds of surgical diseases, there have few reports on total colectomy by SILS. A 3-cm incision was placed in the umbilical fossa, through which a SILS port was placed. And this laparoscopic procedure was started as follows: Firstly, the greater omentum was divided. After the division was extended to both splenic and hepatic sides, each flexure of the colon was taken down. A mesocolon window was created below the descending to horizontal portion of the duodenum. The mesocolon including vessels from the left side of the window to the sigmoid colon was incised by LigaSure without clips. After intestinal transection was performed at the upper side of the rectum with a stapler, ileo-rectal anastomosis was performed by the double stapling technique. Between 2010 and 2012, eight consecutive patients underwent this procedure. The mean operative time was 228.1 (range 205-255) min, the mean operative blood loss was 64.0 (range 0-310) mL, the mean hospitalization after surgery was 10.8 (range 10-12) days, and no postoperative complications were encountered. Single incision clipless laparoscopic total colectomy using our original procedure seems to be feasible and safe.
尽管单切口腹腔镜手术（SILS）已应用于各种外科疾病，但关于SILS全结肠切除术的报道却很少。在脐窝处做一个3厘米的切口，通过该切口置入一个SILS端口。然后按如下步骤开始进行该腹腔镜手术：首先，分离大网膜。当分离延伸至脾侧和肝侧后，将结肠的各弯曲部游离。在十二指肠降部至水平部下方创建一个结肠系膜窗。使用LigaSure器械在不使用钛夹的情况下切开从窗左侧至乙状结肠的包含血管的结肠系膜。在直肠上段用吻合器离断肠管后，采用双吻合器技术行回肠直肠吻合术。在2010年至2012年期间，连续8例患者接受了该手术。平均手术时间为228.1（范围205 - 255）分钟，平均术中失血量为64.0（范围0 - 310）毫升，术后平均住院时间为10.8（范围10 - 12）天，且未出现术后并发症。采用我们的原始手术方法进行单切口无钛夹腹腔镜全结肠切除术似乎是可行且安全的。
