Umbilical-Incision Laparoscopic Surgery with One Assist Port for Right Hemicolectomy: Single Institute Experience

目的：單切口腹腔鏡右側大腸切除術不管在良性或惡性的疾病皆是一個安全且可行的手術。但是單切口腹腔鏡手術仍是有些限制需要外科醫師去克服。我們在這裡提出一個肚臍切口腹腔鏡右側大腸切除併行一個額外的輔助性腹腔鏡套管。方法：一個肚臍旁約三公分的縱向皮膚切口打開至筋膜層上方。將三個五毫米的腹腔鏡套管置入此皮膚切口中，另外在右下腹置入另一個五毫米的腹腔鏡套管中。只要是病灶位於右側大腸皆符合此研究但有腸阻塞及腸穿孔需要緊急手術的病例則予以排除。病人的年齡、性別、手術適應症、術中因子及術後的病理報告皆列入評估。結果：共有62個病例接受肚臍切口腹腔鏡右側大腸切術併行一個額外的輔助性腹腔鏡套管的手術，其中有29個男性及33個女性。其平均年齡為64.5歲，其BMI值之中位數為23.71。手術時間之中位術為172.5分鐘，術中的失血量之中位數為50 c.c.。住院天數之中位數為6天。手術樣本長度之中位數為28公分。取得淋巴結的中位數為22.5。並無在術中轉為傳統剖腹手術之病例且為術後死亡之病例。術後的併發症有五例，包含傷口感染、腸阻塞、腹內膿瘍。結論：和傳統的單切口腹腔鏡右側大腸切除術做比較，肚臍切口腹腔鏡右側大腸切除併行一額外的輔助性腹腔鏡套管（又稱SILS-One）有較好的視野，且傷口的復原、疼痛及美觀並無差異。在右下腹多置入一個額外的輔助性腹腔套管後，手術可在更順暢的情形下進行。

關鍵字

單一切口；腹腔鏡；助性腹腔套管；右側大腸切除術； SILS-One

並列摘要

Purpose. Single-Incision Laparoscopic Surgery (SILS) for right hemicolectomy is a safe and feasible procedure with benign or malignant diseases of the colon. We report a novel umbilical-incision laparoscopic surgery involving one assist port (UILS-One) for right hemicolectomy.Methods. A 3-cm periumbilical longitudinal skin incision was carried down to the fascia layer. Three 5-mm trocars were placed through the incision and another 5-mm trocars was placed in the right lower quadrant. The inclusion criteria were lesions located on the right side of the colon. Patients with obstruction or perforation required emergent operation were excluded. Patient age, gender, surgical indication, intraoperative variables, postoperative condition, and pathology were assessed.Result. A total of 62 patients (29 men and 33 women) underwent umbilical-incision laparoscopic surgery with one assist port (UILS-One) for right hemicolectomy. Patients had a median age of 64.5 years and a median body mass index (BMI) of 23.7 kg/m^2. The median operative time was 172.5 minutes and the mean intraoperative blood loss was 50 ml. The median length of hospital stay was 6 days, the median length of specimen was 28 cm, and the median number of harvested lymph nodes was 23. There was no conversion to open surgery during any of the procedures and there were no mortality associated with the technique. Post-operative complications were noted in five patients, and included wound infection, ileus, and intra-abdominal abscess.Conclusion. Compared with conventional SILS for right hemicolectomy, UILS-One has better surgical triangulation traction and results in fewer wound problems. The operation can be performed more comfortably and smoothly because of the additional port inserted in the right lower quadrant.

並列關鍵字

Single incision ； Laparoscopic surgery ； Assist port ； Right hemicolectomy ； SILS

國際替代計量

Umbilical-Incision Laparoscopic Surgery with One Assist Port for Right Hemicolectomy: Single Institute Experience

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