Balaphas A, Buchs N C, Naiken S P, Hagen M E, Zawodnik A, Jung M K, Varnay G, Bühler L H, Morel P
Division of Digestive and Transplantation Surgery, University Hospitals Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland.
Division of Radiology, University Hospitals Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland.
Hernia. 2017 Oct;21(5):697-703. doi: 10.1007/s10029-017-1621-z. Epub 2017 May 9.
Robotic LaparoEndoscopic Single-Site Surgery Cholecystectomy has been performed for 5 years using a dedicated platform (da Vinci Single-Site) with the da Vinci Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA). While short-term feasibility has been described, long-term assessment of this method is currently outstanding. The aim of this study was to assess long-term parietal complications of this technique.
In this retrospective study, patients operated between 2011 and 2013 were evaluated. Parietal incision was assessed with ultrasonography and patients screened for residual pain from scar tissue. Demographic and perioperative data were also collected.
We evaluated 48 patients [38 female, 79.2%; median age 49 years (range: 24-81 years)]; mean BMI 25.9 kg/m [±SD 4.1 kg/m]. After a median follow-up of 39 months (range: 25-46 months), six incisional hernias (two patients had a positive echography but a negative clinical examination) were found (12.5%, 95% CI 7.5-30.2), and two patients had a surgical repair. The overall rate of incisional hernia was 16.7% (95% CI 7.5-30.2). Residual pain was observed in 5 of 48 patients.
This preliminary study suggests that a clinically significant rate of incisional hernias can occur after R-LESS-C. Larger studies comparing R-LESS-C to alternative methods with long-term follow-up are necessary.
使用达芬奇手术系统（美国加利福尼亚州森尼韦尔市直观外科公司）的专用平台（达芬奇单孔平台）进行机器人单孔腹腔镜胆囊切除术已达5年。虽然已描述了其短期可行性，但目前对该方法的长期评估尚不完善。本研究的目的是评估该技术的长期腹壁并发症。
在这项回顾性研究中，对2011年至2013年期间接受手术的患者进行评估。通过超声检查评估腹壁切口，并对患者进行瘢痕组织残留疼痛筛查。还收集了人口统计学和围手术期数据。
我们评估了48例患者[38例女性，占79.2%；中位年龄49岁（范围：24 - 81岁）]；平均体重指数为25.9kg/m²[±标准差4.1kg/m²]。中位随访39个月（范围：25 - 46个月）后，发现6例切口疝（2例超声检查阳性但临床检查阴性）（12.5%，95%可信区间7.5 - 30.2），2例患者接受了手术修复。切口疝的总体发生率为16.7%（95%可信区间7.5 - 30.2）。48例患者中有5例出现残留疼痛。
这项初步研究表明，机器人单孔腹腔镜胆囊切除术后可能出现临床显著比例的切口疝。有必要进行更大规模的研究，将机器人单孔腹腔镜胆囊切除术与其他方法进行比较，并进行长期随访。
