Suh Suk-Won, Choi YoungRok, Han Ho-Seong, Yoon Yoo-Seok, Cho Jai Young, Choi Yoo-Shin, Lee Seung-Eun, Jeong Jaehong
Department of Surgery, College of Medicine, Chung-Ang University, Seoul, South Korea.
Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
ANZ J Surg. 2019 Jul;89(7-8):900-904. doi: 10.1111/ans.15347. Epub 2019 Jul 10.
Despite the incremental application of single-incision laparoscopic cholecystectomy (SILC), this procedure has technical difficulties, including physical disturbance and an unstable surgical view through the small incision; therefore, we introduce the solo SILC (S-SILC) technique using a laparoscopic scope holder, as a simple, fixed and easy-to-perform procedure for an unassisted surgeon.
We performed a comparative analysis of S-SILC (n = 566) and conventional three-incision laparoscopic cholecystectomy (n = 874) performed from January 2013 to December 2016 at multiple centres.
There was no significant difference of operative time between the two groups (P = 0.176); however, S-SILC showed a higher incidence of intraoperative gallbladder perforation, especially in the initial period (17.0% versus 2.3%, P < 0.001); and shorter post-operative hospital stay (3.3 ± 1.7 versus 1.9 ± 2.7 days, P < 0.001) than conventional three-incision laparoscopic cholecystectomy. There were no significant differences in major post-operative complications between the two groups (P = 0.909) and operation type (P = 0.971) was not a significant risk factor for major post-operative complications in multivariate analysis.
S-SILC is a feasible and safe procedure; however, careful selection of surgical candidates is necessary in the early period of the experience with this method.
尽管单孔腹腔镜胆囊切除术（SILC）的应用日益增加，但该手术存在技术难题，包括身体干扰以及通过小切口获得不稳定的手术视野；因此，我们引入了使用腹腔镜持镜器的单人单孔腹腔镜胆囊切除术（S-SILC）技术，作为一种简单、固定且易于实施的无助手手术方法。
我们对2013年1月至2016年12月在多个中心进行的S-SILC（n = 566）和传统三孔腹腔镜胆囊切除术（n = 874）进行了对比分析。
两组手术时间无显著差异（P = 0.176）；然而，S-SILC术中胆囊穿孔发生率较高，尤其是在初期（17.0%对2.3%，P < 0.001）；且术后住院时间比传统三孔腹腔镜胆囊切除术短（3.3 ± 1.7天对1.9 ± 2.7天，P < 0.001）。两组术后主要并发症无显著差异（P = 0.909），在多因素分析中手术类型（P = 0.971）不是术后主要并发症的显著危险因素。
S-SILC是一种可行且安全的手术方法；然而，在采用该方法的初期，必须谨慎选择手术患者。
