Joshi H M N, Gosselink M P, Adusumilli S, Hompes R, Cunningham C, Lindsey I, Jones O M
Oxford University Hospitals NHS Trust , UK.
Ann R Coll Surg Engl. 2015 Apr;97(3):204-7. doi: 10.1308/003588414X14055925060677.
The advantages of single port surgery remain controversial. This study was designed to evaluate the safety and feasibility of single incision glove port colon resections using a diathermy hook, reusable ports and standard laparoscopic straight instrumentation.
Between June 2012 and February 2014, 70 consecutive patients (30 women) underwent a colonic resection using a wound retractor and glove port. Forty patients underwent a right hemicolectomy through the umbilicus and thirty underwent attempted single port resection via an incision in the right rectus sheath (14 high anterior resection, 13 low anterior resection, 3 abdominoperineal resection).
Sixty-two procedures (89%) were completed without conversion to open or multiport techniques. Four procedures had to be converted and additional ports were needed in four other patients. The postoperative mortality rate was 0%. Complications occurred in six patients (9%). Two cases were R1 while the remainder were R0 with a median nodal harvest of 20 (range: 9-48). The median length of hospital stay was 5 days (range: 3-25 days) (right hemicolectomy: 5 days (range: 3-12 days), left sided resection: 6 days (range: 4-25 days). At a median follow-up of 14 months, no port site hernias were observed.
Single incision glove port surgery is an appropriate technique for different colorectal cancer resections and has the advantage of being less expensive than surgery with commercial single incision ports.
单孔手术的优势仍存在争议。本研究旨在评估使用电刀钩、可重复使用端口和标准腹腔镜直器械进行单切口手套端口结肠切除术的安全性和可行性。
在2012年6月至2014年2月期间,连续70例患者(30例女性)使用伤口牵开器和手套端口进行结肠切除术。40例患者通过脐部进行右半结肠切除术,30例患者尝试通过右腹直肌鞘切口进行单孔切除术(14例高位前切除术,13例低位前切除术,3例腹会阴联合切除术)。
62例手术(89%)无需转为开放或多孔技术即可完成。4例手术必须转为其他方式,另有4例患者需要额外增加端口。术后死亡率为0%。6例患者(9%)出现并发症。2例为R1切除,其余为R0切除,中位淋巴结清扫数为20个(范围:9 - 48个)。中位住院时间为5天(范围:3 - 25天)(右半结肠切除术:5天(范围:3 - 12天),左侧切除术:6天(范围:4 - 25天)。中位随访14个月时,未观察到端口部位疝。
单切口手套端口手术是一种适用于不同结直肠癌切除术的技术,并且具有比使用商业单切口端口手术成本更低的优势。