Hirano Yasumitsu, Hiranuma Chikashi, Hattori Masakazu, Douden Kenji, Yamaguchi Shigeki
Department of Gastroenterological Surgery, Saitama Medical University, International Medical Center, Saitama, Japan.
Department of Surgery, Fukui Prefectural Hospital, Fukui, Japan.
Surg Technol Int. 2020 May 28;36:132-135.
Single-incision laparoscopic surgery (SILS) and single-incision plus one-port laparoscopic surgery (SILS+1) for colorectal cancer are considered to require long operative times, experienced surgeons, and advanced surgical techniques. However, these procedures are advantageous because they require both fewer ports and fewer surgeons.
In the SILS procedure for colon cancer, a Lap Protector™ (LP; Hakkou Shoji, Japan) is inserted through a 2.5 cm transumbilical incision. Next, an EZ-Access (Hakkou Shoji, Japan) is mounted onto the LP, and three ports are made in the EZ-Access. In SILS+1 for rectal cancer, we use an extra incision in the lower quadrant for drainage from the beginning of the operation. Data from 849 patients who underwent elective surgery with SILS or SILS+1 for colorectal cancer were reviewed.
In 808 patients who underwent a reduced-port procedure for colorectal cancer, the mean incision length was 2.91 cm. The average operative time was 198.2 minutes, and average intra-operative blood loss was 25.6 mL. Complications with a Clavien-Dindo classification of II or greater occurred in 63 patients (7.2%). Among 654 stage I-III colorectal cancer patients, 69 (10.6%) experienced postoperative relapse during the follow-up period of 42 months.
Our cumulative findings support the use of SILS or SILS+1 in patients with colorectal cancer. The long-term oncologic outcomes make them acceptable technical alternatives to conventional multiport laparoscopic colectomy. Further trials are still needed to fully document the non-cosmetic benefits.
用于结直肠癌的单切口腹腔镜手术（SILS）和单切口加单孔腹腔镜手术（SILS+1）被认为需要较长的手术时间、经验丰富的外科医生以及先进的手术技术。然而，这些手术方式具有优势，因为它们所需的切口和外科医生数量更少。
在结肠癌的SILS手术中，通过一个2.5厘米的脐部切口插入Lap Protector™（LP；日本八光商事）。接下来，将EZ-Access（日本八光商事）安装在LP上，并在EZ-Access上制作三个切口。在直肠癌的SILS+1手术中，我们从手术开始就在下象限额外做一个切口用于引流。回顾了849例行SILS或SILS+1择期结直肠癌手术患者的数据。
在808例行结直肠癌减孔手术的患者中，平均切口长度为2.91厘米。平均手术时间为198.2分钟，平均术中失血量为25.6毫升。Clavien-Dindo分类为II级或更高的并发症发生在63例患者中（7.2%）。在654例I-III期结直肠癌患者中，69例（10.6%）在42个月的随访期内出现术后复发。
我们的累积研究结果支持在结直肠癌患者中使用SILS或SILS+1。长期的肿瘤学结果使它们成为传统多端口腹腔镜结肠切除术可接受的技术替代方案。仍需要进一步的试验来充分记录其非美容方面的益处。
