Ishikawa Masashi, Asanoma Michihito, Tashiro Yoshihiko, Takechi Hirokazu, Matsuyama Kazuo, Miyauchi Takayuki
Department of Surgery, Shikoku Central Hospital, Shikokuchuo, Japan.
J Minim Invasive Surg. 2021 Sep 15;24(3):152-157. doi: 10.7602/jmis.2021.24.3.152.
Single-port laparoscopic surgery is anticipated to become the future of minimally invasive surgery. We have devised an alternative approach for laparoscopic cholecystectomy by inserting a single port at the umbilicus and using the abdominal wall-lifting method, without establishing pneumoperitoneum.
Retrospective analysis of 130 patients undergoing laparoscopic cholecystectomy was done to compare the conventional laparoscopic cholecystectomy (CLC) (n = 69) and the novel single-port laparoscopic cholecystectomy (SLC) using the abdominal wall-lifting method (n = 61). The surgical procedures were as follows. A 2- to 3-cm transumbilical incision was made, and a wound retractor was inserted into the abdomen without difficulty. Abdominal distension was obtained using a fan-shaped retractor without the use of carbon dioxide insufflations. A 5-mm flexible scope and modified curved graspers and dissectors were used to give the feeling of triangulation during dissection.
The SLC group consisted of 25 males and 36 females with a mean age of 58.1 ± 7.2 years and a mean body mass index of 23.1 ± 3.2 kg/m. The two groups were comparable for mean age, sex, disease, American Society of Anesthesiologists physical status classification, and comorbidity. Likewise, the duration of operation, postoperative hospital stays, complications, the number of use of analgesics, and conversion rate to open technique were not significantly different in the two groups.
The impaired view in single-port laparoscopic surgery can be improved by using articulating instruments that can be rotated out of the field of view. This novel gasless method is cost-effective and produces minimal postoperative discomfort with no additional scars.
单孔腹腔镜手术有望成为微创手术的未来发展方向。我们设计了一种替代性的腹腔镜胆囊切除术方法，即在脐部插入单孔并采用腹壁提升法，无需建立气腹。
对130例行腹腔镜胆囊切除术的患者进行回顾性分析，比较传统腹腔镜胆囊切除术（CLC）（n = 69）和采用腹壁提升法的新型单孔腹腔镜胆囊切除术（SLC）（n = 61）。手术步骤如下。做一个2至3厘米的经脐切口，将伤口牵开器顺利插入腹腔。使用扇形牵开器获得腹部扩张，不使用二氧化碳气腹。使用5毫米的可弯曲内镜以及改良的弯曲抓钳和解剖器，在解剖过程中营造三角操作的感觉。
SLC组包括25名男性和36名女性，平均年龄为58.1±7.2岁，平均体重指数为23.1±3.2kg/m。两组在平均年龄、性别、疾病、美国麻醉医师协会身体状况分级和合并症方面具有可比性。同样，两组在手术时间、术后住院时间、并发症、镇痛药物使用次数和转为开放手术的比例方面无显著差异。
通过使用可旋转出视野的关节式器械，可以改善单孔腹腔镜手术中视野受限的问题。这种新型无气腹方法具有成本效益，术后不适最小，且无额外疤痕。
