Karam Paul Anthony, Hiuser Amy, Magnuson David, Seifarth Federico Gian Filippo
Department of Pediatric Surgery, Cleveland Clinic Foundation, Cleveland, OH.
Pediatr Med Chir. 2016 Dec 20;38(3):133. doi: 10.4081/pmc.2016.133.
Transumbilical laparoscopic assisted appendectomy combines laparoscopic single port dissection with open appendectomy after exteriorization of the appendix through the port site. Compared to the conventional three-port approach, this technique provides an alternative with excellent cosmetic outcome. We developed a safe and effective technique to perform an intracorporeal single port appendectomy, using the same laparoscope employed in the extracorporeal procedure. Retrospective review of 71 consecutively performed intracorporeal single port appendectomies and 30 conventional three-port appendectomies in children 6 to 17 years of age. A straight 10-mm Storz telescope with inbuilt 6 mm working channel is used to dissect the appendix, combined with one port-less 2.3 mm percutaneous grasper. Polymer WECK® hem-o-lock® clips are applied to seal the base of the appendix and the appendiceal vessels. No intraoperative complications were reported with the hybrid intracorporeal single port appendectomy or three-port appendectomy. There were two post-operative complications in the group treated with the single port hybrid technique: one intra-abdominal abscess and one surgical site infection. Groups did not differ in age, weight, and types of appendicitis. Operative times were shorter for the hybrid technique (70 vs 79 minutes) but did not differ significantly (P=0.19). This modified technique to a previously described single port extracorporeal appendectomy is easy to master and implement. It provides exposure similar to a three-port laparoscopic appendectomy, while maintaining virtually scarless results and potentially reduces the risk for surgical site infections compared to the extracorporeal technique.
经脐腹腔镜辅助阑尾切除术是将腹腔镜单孔解剖与通过端口部位将阑尾外置后行开放阑尾切除术相结合。与传统的三孔法相比，该技术提供了一种具有极佳美容效果的替代方法。我们开发了一种安全有效的技术来进行体内单孔阑尾切除术，使用与体外手术相同的腹腔镜。对6至17岁儿童连续进行的71例体内单孔阑尾切除术和30例传统三孔阑尾切除术进行回顾性分析。使用带有内置6毫米工作通道的直型10毫米史托斯望远镜来解剖阑尾，并结合一个无端口的2.3毫米经皮抓钳。应用聚合威克®血管锁®夹来封闭阑尾根部和阑尾血管。混合体内单孔阑尾切除术或三孔阑尾切除术均未报告术中并发症。单孔混合技术治疗组有2例术后并发症：1例腹腔内脓肿和1例手术部位感染。两组在年龄、体重和阑尾炎类型方面无差异。混合技术的手术时间较短（70分钟对79分钟），但差异无统计学意义（P=0.19）。这种对先前描述的单孔体外阑尾切除术的改良技术易于掌握和实施。它提供了与三孔腹腔镜阑尾切除术相似的视野，同时保持几乎无瘢痕的效果，并且与体外技术相比可能降低手术部位感染的风险。
