Gerhart C D
JSLS. 1998 Jul-Sep;2(3):295-8.
As the use of laparoscopic techniques have expanded to more complicated procedures, limitations of laparoscopy have begun to be realized. To help regain the ability to palpate and bluntly dissect tissues, and handle larger organs, surgeons have begun to utilize devices which allow the surgeon's hand to be inserted into the abdomen during laparoscopic procedures. One such devices is the Dexterity Pneumo Sleeve, which was used here to perform transhiatal esophagectomy in two patients.
Two patients with adenocarcinoma of the esophagus underwent hand-assisted laparoscopic transhiatal esophagectomy. The stomach mobilization was carried out using laparoscopic technique facilitated by the use of the surgeon's hand. Blunt dissection of the esophagus through the hiatus was then carried out. Dissection of the proximal esophagus and creation of a cervical esophagogastric anastomosis was then performed in the neck through a cervical incision.
The Pneumo Sleeve proved useful for handling the stomach, as well as, blunt dissection of the esophagus while still maintaining the benefits of laparoscopy, including small incisions, and no postoperative ileus.
Hand-assisted laparoscopic esophagectomy can be carried out with good, early, postoperative recovery.
随着腹腔镜技术应用于越来越复杂的手术，腹腔镜的局限性已开始显现。为了恢复触诊和钝性分离组织以及处理更大器官的能力，外科医生已开始使用能让术者手部在腹腔镜手术过程中插入腹腔的设备。其中一种设备是灵巧充气袖套，本文用其为两名患者实施经裂孔食管切除术。
两名食管腺癌患者接受了手辅助腹腔镜经裂孔食管切除术。利用术者手部辅助，通过腹腔镜技术游离胃。然后经裂孔钝性分离食管。接着通过颈部切口在颈部进行食管近端的分离并制作颈段食管胃吻合术。
充气袖套被证明在处理胃部以及钝性分离食管时很有用，同时还能保留腹腔镜手术的优点，包括小切口以及无术后肠梗阻。
手辅助腹腔镜食管切除术可实现良好的早期术后恢复。
