Hirahara Noriyuki, Matsubara Takeshi, Kaji Shunsuke, Uchida Yuki, Yamamoto Tetsu, Hyakudomi Ryoji, Zotani Hitomi, Kawakami Koki, Sasaki Yuhei, Tajima Yoshitsugu
Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Japan.
Department of Surgery, Matsue Red Cross Hospital, Japan.
Ann Med Surg (Lond). 2021 Nov 2;71:103001. doi: 10.1016/j.amsu.2021.103001. eCollection 2021 Nov.
The overall incidence of port site hernias in laparoscopy and robot-assisted surgeries ranges from 0% to 5.2%. Sufficient port site closure is essential to reduce and prevent the occurrence of port site hernia. However, complete fascial closure of 8-mm robot-port site appears to be difficult. In this study, we propose a safe and reliable robot-assisted port-site closure for robot-assisted gastrectomy.
The robotic arm was tilted 60-70° cranially or caudally to create a small gap between the port and the skin margin that was cut open for port insertion. While viewing through the robotic camera and grasping the polydioxanone (PDS) thread, the Lapa-Her-Closure was inserted into the peritoneal cavity through the gap. The Lapa-Her-Closure was removed after the PDS thread was grasped with robotic forceps. Subsequently, the Lapa-Her-Closure was inserted into the abdominal cavity by tilting the arm cranially or caudally, in contrast to the previous step. The PDS thread was inserted into the loop wire using robotic forceps. After tightening the loop wire and grasping the PDS thread, the Lapa-Her-Closure was removed, and the PDS thread was ligated to complete the abdominal wall closure, with total closure of the fascia and peritoneum.
We utilized this port site closure technique in 12 patients who underwent robot-assisted gastrectomy for gastric cancer. The procedure was accomplished safely and efficiently in all cases without any technical problems. In conclusion, our port site closure is safe, reliable, and efficient procedure that can be performed using basic surgical techniques.
腹腔镜手术和机器人辅助手术中切口疝的总体发生率为0%至5.2%。充分关闭切口对于减少和预防切口疝的发生至关重要。然而，完全关闭8毫米机器人辅助手术切口的筋膜似乎很困难。在本研究中，我们提出了一种用于机器人辅助胃癌根治术的安全可靠的机器人辅助切口关闭方法。
将机器人手臂向头侧或尾侧倾斜60-70°，在端口与为插入端口而切开的皮肤边缘之间形成一个小间隙。通过机器人摄像头观察并抓住聚二氧六环酮（PDS）线时，将Lapa-Her-Closure通过该间隙插入腹腔。在用机器人镊子抓住PDS线后，将Lapa-Her-Closure取出。随后，与上一步相反，通过将手臂向头侧或尾侧倾斜，将Lapa-Her-Closure插入腹腔。用机器人镊子将PDS线插入环形钢丝中。收紧环形钢丝并抓住PDS线后，取出Lapa-Her-Closure，结扎PDS线以完成腹壁关闭，实现筋膜和腹膜的完全闭合。
我们对12例行机器人辅助胃癌根治术的患者采用了这种切口关闭技术。所有病例均安全有效地完成了该操作，未出现任何技术问题。总之，我们的切口关闭方法是一种安全、可靠且高效的操作，可使用基本的外科技术完成。
