Machado Marcel Autran, Makdissi Fabio F, Surjan Rodrigo C
Department of Surgery, Sirio Libanes Hospital.
Arq Bras Cir Dig. 2014 Apr-Jun;27(2):157-9. doi: 10.1590/s0102-67202014000200015.
Laparoscopic gastrointestinal resections using single-port are possible, but triangulation problems and the need of articulated instruments difficult the procedures.
To present a surgical alternative using single-port laparoscopic device on gastric resection.
The patient is placed in a supine and reverse Trendelenburg position with surgeon between patient's legs. First assistant was on the right side of the patient with the monitor placed on the patient's cranial side. With the patient under general anesthesia, a transumbilical 3 cm skin incision is performed. A single-incision advanced access platform with gelatin cap, self-retaining sleeve and wound protector is introduced through this incision. Three 5-12 mm operating ports were introduced through the single-port device. Due to the gel cap and sleeves, no articulated instruments are necessary. CO2 pneumoperitoneum is established at 12 mmHg. A rigid 30 degree 10 mm laparoscope is introduced. Operation begins with access to the lesser sac by opening the omentum along the greater curvature of the stomach using harmonic scalpel. Once the stomach is fully exposed and a stay suture is place around the tumor. Gastric wall is divided with cautery 1 cm away from the tumor. Tumor is excised. Gastric wall is sutured with two-layer running suture. No drain was used. Umbilical incision was closed.
This procedure was used in one patient with gastric duplication. Operative time was 200 minutes. Blood loss was minimal. Recovery was uneventful and patient discharged on postoperative day 2. Final aspect of the umbilical incision was good.
Gastric resection with single-port laparoscopic platform is feasible and may be safely performed in selected patients.
使用单孔进行腹腔镜胃肠道切除术是可行的，但三角定位问题以及对关节式器械的需求使手术过程变得困难。
介绍一种在胃切除术中使用单孔腹腔镜设备的手术替代方法。
患者取仰卧位，头低脚高位，外科医生站在患者双腿之间。第一助手位于患者右侧，监视器置于患者头侧。患者全身麻醉后，经脐部做一个3厘米的皮肤切口。通过该切口插入一个带有明胶帽、自固定套管和伤口保护器的单切口高级接入平台。通过单孔设备插入三个5 - 12毫米的操作端口。由于有明胶帽和套管，无需使用关节式器械。建立12毫米汞柱的二氧化碳气腹。插入一个10毫米的30度硬性腹腔镜。手术开始时，使用超声刀沿胃大弯打开网膜进入小网膜囊。一旦胃完全暴露，在肿瘤周围放置一根牵引缝线。在距肿瘤1厘米处用电灼法切开胃壁。切除肿瘤。胃壁用两层连续缝线缝合。未放置引流管。关闭脐部切口。
该手术应用于一名胃重复畸形患者。手术时间为200分钟。出血量极少。恢复顺利，患者术后第2天出院。脐部切口最终外观良好。
使用单孔腹腔镜平台进行胃切除术是可行的，在选定患者中可安全实施。
