Bedaiwy Mohamed A, Farghaly Tarek, Hurd William, Liu James, Mansour Gihan, Fader Amanda Nickles, Escobar Pedro
University Hospitals Case Medical Center, Case Western Reserve University, OH, USA; Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia D415A4500 Oak Street Vancouver, BC V6H 3N1, Canada.
University Hospitals Case Medical Center, Case Western Reserve University, OH, USA.
JSLS. 2014 Apr-Jun;18(2):191-6. doi: 10.4293/108680813X13794522666284.
To compare our initial experience in laparoscopic surgery for ovarian endometriomas performed through an umbilical incision using a single 3-channel port and flexible laparoscopic instrumentation versus traditional laparoscopy.
This study was conducted in 3 tertiary care referral centers. Since September 2009, we have performed laparoendoscopic single-site surgery in 24 patients diagnosed with ovarian endometriomas. A control group of patients with similar diagnoses who underwent traditional operative laparoscopy during the same period was included (n = 28). In the laparoendoscopic single-site surgery group, a multichannel port was inserted into the peritoneum through a 1.5- to 2.0-cm umbilical incision.
Patients in the laparoendoscopic single-site surgery group were significantly older (P = .04) and had a higher body mass index (P = .005). Both groups were comparable regarding history of abdominal surgery, lateral pelvic side wall involvement, and cul-de-sac involvement. After we controlled for age and body mass index, the size of the resected endometriomas, duration of surgery, and amount of operative blood loss were comparable in both groups. When required, an additional 5-mm port was inserted in the right or left lower quadrant in the laparoendoscopic single-site surgery group to allow the use of a third instrument for additional tissue retraction or manipulation (10 of 24 patients, 41.6%). However, adhesiolysis was performed more frequently in the conventional laparoscopy group. The duration of hospital stay was <24 hours in both groups. No intraoperative complications were encountered. All incisions healed and were cosmetically satisfactory.
The laparoendoscopic single-site surgery technique is a reasonable initial approach for the treatment of endometriomas. In our experience, an additional side port is usually needed to treat pelvic side wall and cul-de-sac endometriosis that often accompanies endometriomas.
比较我们使用单个三通道端口和可弯曲腹腔镜器械经脐部切口进行腹腔镜手术治疗卵巢子宫内膜异位囊肿的初步经验与传统腹腔镜手术。
本研究在3个三级医疗转诊中心进行。自2009年9月起，我们对24例诊断为卵巢子宫内膜异位囊肿的患者进行了腹腔镜单孔手术。纳入同期接受传统手术腹腔镜检查且诊断相似的对照组患者（n = 28）。在腹腔镜单孔手术组中，通过1.5至2.0厘米的脐部切口将多通道端口插入腹膜。
腹腔镜单孔手术组患者年龄显著较大（P = 0.04），体重指数较高（P = 0.005）。两组在腹部手术史、盆腔侧壁受累情况和直肠子宫陷凹受累情况方面具有可比性。在控制年龄和体重指数后，两组切除的子宫内膜异位囊肿大小、手术时间和术中失血量相当。必要时，腹腔镜单孔手术组在右下腹或左下腹额外插入一个5毫米端口，以便使用第三把器械进行额外的组织牵拉或操作（24例患者中的10例，41.6%）。然而，传统腹腔镜检查组粘连松解术的实施更为频繁。两组患者住院时间均<24小时。未发生术中并发症。所有切口均愈合，外观满意。
腹腔镜单孔手术技术是治疗子宫内膜异位囊肿的一种合理的初始方法。根据我们的经验，治疗常伴随子宫内膜异位囊肿的盆腔侧壁和直肠子宫陷凹子宫内膜异位症通常需要额外的侧端口。
