Gibor Udit, Perry Zvi, Domchik Sergey, Mizrahi Solly, Kirshtein Boris
Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva, Israel .
J Laparoendosc Adv Surg Tech A. 2018 Jan;28(1):65-70. doi: 10.1089/lap.2017.0331. Epub 2017 Oct 4.
Single-incision laparoscopic surgery (SILS) was introduced to further the enhanced outcome of conventional multiport laparoscopy (CML). We compared their short- and long-term outcomes in colorectal surgery.
Retrospective review of patients who underwent elective laparoscopic colorectal surgery during 3-year period. Patients' data, surgery outcomes, and oncological results were compared.
Sixty-one patients (33 male, 28 female), mean age 67.4 years, underwent laparoscopic colonic resections: 28 SILS and 33 CML. Twenty-three (37.7%) patients had previous abdominal surgery. There were 19 (31.2%) right, 9 (14.7%) left, and 2 (3.3%) total colectomies, 16 (26.2%) sigmoidectomies, 13 (21.3%) anterior and 2 (3.3%) abdominoperineal resections. Colonic malignancy was a main indication for the surgery in 51 (83.6%) patients. Mean surgery time and postoperative stay were 92.0 minutes and 9 days, respectively. Pathological examination revealed stage I colon cancer in 16 (32%), stage II in 22 (44%), stage III in 10 (20%), and stage IV in 2 (4%) patients. Mean number of retrieved lymph nodes was 19 ± 13.5. No differences were found between groups in demographic data, type of surgery, surgery time and hospital stay, pathological results and tumor staging, and disease-free and overall survivals. In the SILS group, placement of additional trocar was required in 7 (25%) and conversion in 3 (10.7%) cases compared with 1 (3%) case of conversion to formal laparotomy in the CML group. Overall postoperative morbidity was 16.4%. There was no mortality in both the groups. During the study period, 3 patients from the CML group had cancer recurrence.
SILS is a feasible and safe technique compared with CML in terms of surgical and oncological outcomes.
单孔腹腔镜手术（SILS）的引入是为了进一步提高传统多孔腹腔镜手术（CML）的疗效。我们比较了它们在结直肠手术中的短期和长期疗效。
回顾性分析3年内接受择期腹腔镜结直肠手术的患者。比较患者数据、手术结果和肿瘤学结果。
61例患者（男33例，女28例），平均年龄67.4岁，接受了腹腔镜结肠切除术：28例单孔腹腔镜手术和33例传统多孔腹腔镜手术。23例（37.7%）患者曾接受过腹部手术。有19例（31.2%）右半结肠切除术、9例（14.7%）左半结肠切除术、2例（3.3%）全结肠切除术、16例（26.2%）乙状结肠切除术、13例（21.3%）前切除术和2例（3.3%）腹会阴联合切除术。结肠恶性肿瘤是51例（83.6%）患者手术的主要指征。平均手术时间和术后住院时间分别为92.0分钟和9天。病理检查显示，16例（32%）患者为Ⅰ期结肠癌，22例（44%）为Ⅱ期，10例（20%）为Ⅲ期，2例（4%）为Ⅳ期。平均回收淋巴结数为19±13.5个。两组在人口统计学数据、手术类型、手术时间和住院时间、病理结果和肿瘤分期以及无病生存率和总生存率方面均未发现差异。在单孔腹腔镜手术组中，7例（25%）需要额外放置套管针，3例（10.7%）需要中转手术，而在传统多孔腹腔镜手术组中，有1例（3%）需要中转开腹手术。总体术后发病率为16.4%。两组均无死亡病例。在研究期间，传统多孔腹腔镜手术组有3例患者出现癌症复发。
在手术和肿瘤学结果方面，与传统多孔腹腔镜手术相比，单孔腹腔镜手术是一种可行且安全的技术。
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