Umeda Shinichi, Hachisuka Takehiro, Otsu Tomohisa, Hishida Mitsuhiro, Nagai Satomi, Shimizu Minoru, Kobayashi Hiroyuki, Nozaki Hideki
Department of Surgery, Meitetsu Hospital, 2-26-11 Sakou, Nishi-ku, Nagoya, Aichi, Japan.
Department of Surgery, Yokkaichi Municipal Hospital, 2-37 Shibata, Yokkaichi, Mie, Japan.
Int J Surg Case Rep. 2018;51:170-173. doi: 10.1016/j.ijscr.2018.08.047. Epub 2018 Aug 28.
Recently, use of reduced-port surgery has become widespread; however, it is a difficult operation. Hachisuka et al. developed a method called the umbilical zigzag incision, which enlarges the fascial incision using only an umbilical skin incision. We believe this method will be feasible for concomitant laparoscopic surgery. We report our surgical techniques for concomitant laparoscopic surgery using an umbilical zigzag incision.
The patient who should receive more than 2 places of abdominal operation were indicated this procedure. In all cases, we made the zigzag incision in the umbilical region. After the linea alba and peritoneum were incised, the wound retractor was inserted through the incision, which enlarges the fascial opening. GelPoint was attached to the wound retractor and the operation was started.
We could create a fascial opening of up to 6 cm with the umbilical zigzag incision, which improves the triangulation of forceps and reduces interference among the trocars. The trocars in the center of the abdomen could be utilized for almost all intraperitoneal operations. This procedure was especially useful in cases that included lymph node dissection because dissection of a malignant tumor is a delicate procedure. Furthermore, extraction of specimens and anastomosis went very smoothly because the fascial incision was large enough such that no extension of the incision was needed. No early or late postoperative complications occurred in any case. Postoperative wounds were clear and therefore patient satisfaction levels were high.
Umbilical zigzag incision may be feasible especially in concomitant laparoscopic surgery.
近年来，减孔手术的应用已变得广泛；然而，这是一种难度较大的手术。蜂须贺等人开发了一种名为脐部锯齿状切口的方法，该方法仅通过脐部皮肤切口来扩大筋膜切口。我们认为这种方法对于同期腹腔镜手术将是可行的。我们报告使用脐部锯齿状切口进行同期腹腔镜手术的手术技术。
适合接受超过2处腹部手术的患者被纳入该手术。在所有病例中，我们在脐部区域做锯齿状切口。切开白线和腹膜后，将伤口牵开器通过切口插入，从而扩大筋膜开口。将GelPoint附着于伤口牵开器上并开始手术。
通过脐部锯齿状切口，我们能够创建一个达6厘米的筋膜开口，这改善了钳子的三角定位并减少了套管针之间的干扰。腹部中央的套管针可用于几乎所有的腹腔内手术。该手术在包括淋巴结清扫的病例中特别有用，因为恶性肿瘤的清扫是一个精细的操作。此外，标本的取出和吻合进行得非常顺利，因为筋膜切口足够大，无需延长切口。所有病例均未发生早期或晚期术后并发症。术后伤口清洁，因此患者满意度较高。
脐部锯齿状切口可能是可行的，特别是在同期腹腔镜手术中。
