Choi Byung Jo, Jeong Won Jun, Kim Say-June, Lee Sang Chul
Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Daejeon, Republic of Korea.
J Laparoendosc Adv Surg Tech A. 2018 Mar;28(3):330-336. doi: 10.1089/lap.2017.0375. Epub 2017 Aug 22.
To report our experience with solo-surgeon, single-port laparoscopic anterior resection (solo SPAR) for sigmoid colon cancer.
Data from sigmoid colon cancer patients who underwent anterior resections (ARs) using the single-port, solo surgery technique (n = 31) or the conventional single-port laparoscopic technique (n = 45), between January 2011 and July 2016, were retrospectively analyzed. In the solo surgeries, making the transumbilical incision into the peritoneal cavity was facilitated through the use of a self-retaining retractor system. After establishing a single port through the umbilicus, an adjustable mechanical camera holder replaced the human scope assistant. Patient and tumor characteristics and operative, pathologic, and postoperative outcomes were compared.
The operative times and estimated blood losses were similar for the patients in both treatment groups. In addition, most of the postoperative variables were comparable between the two groups, including postoperative complications and hospital stays. In the solo SPAR group, comparable lymph nodes were attained, and sufficient proximal and distal cut margins were obtained. The difference in the proximal cut margin significantly favored the solo SPAR, compared with the conventional AR group (P = .000).
This study shows that solo SPAR, using a passive camera system, is safe and feasible for use in sigmoid colon cancer surgery, if performed by an experienced laparoscopic surgeon. In addition to reducing the need for a surgical assistant, the oncologic requirements, including adequate margins and sufficient lymph node harvesting, could be fulfilled. Further evaluations, including prospective randomized studies, are warranted.
报告我们在乙状结肠癌单术者单孔腹腔镜前切除术（单术者单孔乙状结肠前切除术）方面的经验。
回顾性分析2011年1月至2016年7月期间，采用单孔单术式技术（n = 31）或传统单孔腹腔镜技术（n = 45）进行前切除术（AR）的乙状结肠癌患者的数据。在单术式手术中，使用自固定牵开器系统便于经脐切口进入腹腔。通过脐部建立单孔后，一个可调节的机械摄像头固定器取代了人工持镜助手。比较患者和肿瘤特征以及手术、病理和术后结果。
两个治疗组患者的手术时间和估计失血量相似。此外，两组之间的大多数术后变量具有可比性，包括术后并发症和住院时间。在单术者单孔乙状结肠前切除术组中，获得了相当数量的淋巴结，并且获得了足够的近端和远端切缘。与传统前切除术组相比，近端切缘的差异明显有利于单术者单孔乙状结肠前切除术组（P = 0.000）。
本研究表明，如果由经验丰富的腹腔镜外科医生进行，使用被动摄像头系统的单术者单孔乙状结肠前切除术在乙状结肠癌手术中是安全可行的。除了减少对手术助手的需求外，还可以满足包括足够切缘和充分淋巴结清扫在内的肿瘤学要求。需要进行进一步评估，包括前瞻性随机研究。
