Russell Thomas B, Aroori Somaiah
Clinic of Hepatopancreaticobiliary Surgery, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom.
Turk J Surg. 2021 Dec 31;37(4):413-416. doi: 10.47717/turkjsurg.2021.5452. eCollection 2021 Dec.
The number of patients with obesity is set to rise, as is the proportion with severe obesity. These patients are a high-risk subgroup who present addi- tional challenges to the surgeon when performing laparoscopic cholecystectomy. It is important that all surgeons who perform this procedure have a safe strategy they can revert to. This article outlines our approach. After obtaining pneumoperitoneum via a supra-umbilical incision, we advise placing a fascial suture before proceeding with the operation. This allows for high-quality closure, reduces the incidence of incisional hernia, and reduces the risk of inadvertent bowel injury. We also advise the repositioning of the patient on the operating table prior to port placement such that an ergonomic set-up can be achieved. In addition to standard ports, we use an additional twelve-millimetre port in the left upper quadrant. A fan retractor can be inserted via this port and used to gently retract the duodenum inferiorly. This provides adequate exposure for Calot's dissection and arguably reduces the risk of injury to a fatty liver. This technique can also be used in non-obese patients in whom Calot's dissection is particularly challenging, for instance in those who undergo delayed cholecystectomy.
肥胖患者的数量以及重度肥胖患者的比例都将上升。这些患者是一个高危亚组，在进行腹腔镜胆囊切除术时给外科医生带来了额外的挑战。所有进行该手术的外科医生都必须有一个可以采用的安全策略，这一点很重要。本文概述了我们的方法。通过脐上切口建立气腹后，我们建议在继续手术前放置筋膜缝线。这有助于实现高质量的缝合，降低切口疝的发生率，并降低意外肠损伤的风险。我们还建议在放置端口前将患者重新安置在手术台上，以便实现符合人体工程学的设置。除了标准端口外，我们在左上象限使用一个额外的12毫米端口。可以通过这个端口插入扇形牵开器，用于将十二指肠轻轻向下牵开。这为胆囊三角的解剖提供了足够暴露，并且可以说降低了脂肪肝损伤的风险。该技术也可用于胆囊三角解剖特别具有挑战性的非肥胖患者，例如那些接受延迟胆囊切除术的患者。
