Kashiwagi Hiroyuki, Kumagai Kenta, Monma Eiji, Nozue Mutsumi
Department of Surgery, Shonai Amarume Hospital, Shouyou 1-1-1, Shonai Town, Higashi-Tagawa, 999-7782, Japan,
Surg Endosc. 2015 Jun;29(6):1321-6. doi: 10.1007/s00464-014-3827-9. Epub 2014 Aug 27.
Although recent trends in laparoscopic procedures have been toward minimizing the number of incisions, four or five ports are normally required to complete laparoscopic gastrectomy because of the complexity of this procedure. Multi-channel ports, such as the SILS port (Covidien, JAPAN), are now available and are crucial for performing single-incision laparoscopic surgery (SILS) or reduced port surgery (RPS). We carried out reduced port distal gastrectomy (RPDG) using a dual-port method with a SILS port.
Ten patients who were diagnosed as early stage gastric cancer were offered the RPDG. Mean age and body mass index (BMI) were 68.1 and 21.4, respectively. No distant metastasis or regional lymph node swelling was seen in any case. A 5-mm flexible scope (Olympus, JAPAN) and SILS port were used and a nylon ligature with a straight needle, instead of a surgical instrument, was available to raise the gastric wall.
The average operative time was 266.9 ± 38.3 min and blood loss was 37.8 ± 56.8 ml. Patients recovered well and experienced no complications after surgery. All patients could tolerate soft meals on the first day after surgery and the average hospital stay was 8.1 days. Past conventional LAG cases were evaluated to compare the short-term outcome and no difference was seen in the mean operative time or operative blood loss. The length of hospital stay after surgery was shorter for the RPDG group than the conventional operation group (p < 0.0001). Interestingly, the trend of serum CRP elevation after surgery was lower in the RPDG group than the conventional LAG group (p = 0.053).
Although the benefits of RPS have not been established, this type of surgery may be expected to have some advantages. Cosmetic benefits and shorter hospital stays are clear advantages. Less invasiveness can be expected according to the trend of serum CRP elevation after RPDG.
尽管腹腔镜手术的近期趋势是尽量减少切口数量，但由于该手术的复杂性，通常需要四到五个端口才能完成腹腔镜胃切除术。多通道端口，如SILS端口（柯惠医疗，日本），现已可用，对于进行单切口腹腔镜手术（SILS）或减少端口手术（RPS）至关重要。我们采用带有SILS端口的双端口方法进行了减少端口远端胃切除术（RPDG）。
向10例被诊断为早期胃癌的患者提供RPDG手术。平均年龄和体重指数（BMI）分别为68.1和21.4。所有病例均未发现远处转移或区域淋巴结肿大。使用了一个5毫米的柔性内窥镜（奥林巴斯，日本）和SILS端口，并且可以使用带直针的尼龙结扎线而不是手术器械来提起胃壁。
平均手术时间为266.9±38.3分钟，失血量为37.8±56.8毫升。患者恢复良好，术后无并发症。所有患者术后第一天即可耐受软食，平均住院时间为8.1天。对过去传统腹腔镜辅助胃切除术（LAG）病例进行评估以比较短期结果，平均手术时间或手术失血量无差异。RPDG组术后住院时间比传统手术组短（p<0.0001）。有趣的是，RPDG组术后血清CRP升高的趋势低于传统LAG组（p = 0.053）。
尽管RPS的益处尚未得到证实，但这种类型的手术可能具有一些优势。美容效果和较短的住院时间是明显的优势。根据RPDG术后血清CRP升高的趋势，可以预期其侵袭性较小。
