Staple-less and 4-Port Laparoscopic Radical Cystectomy

無釘針四套管式腹腔鏡根除性膀胱切除術

李永樹(Yung-Shu Lee) ； 林文榮(Wun-Rong Lin) ； 楊志東(Stone Yang) ； 林文州(Wen-Chou Lin) ； 張奐光(Huang-Kuang Chang) ； 許炯明(Jong-Ming Hsu) ； 江百凱(Pai-Kai Chiang) ； 蔡維恭(Wei-Kung Tsai) ； 邱文祥(Allen W. Chiu)

《臺灣泌尿科醫學會雜誌》 16卷4期 (2005/12) Pp. 146-151

摘要

腹腔鏡根除性膀胱切除術是一種相當具挑戰的手術，花費時間甚長且有多種合併症。我們於2002年3月至2004年9月收集了8例病患，均為侵襲性膀胱癌並接受腹腔鏡根除性膀胱切除術。有3位男性及5位女性，平均年齡為60歲。前2位病患使用手助式腹腔鏡膀胱切除術，接下來之2位病患使用5個套管，而最後4位病患均使用4個套管。全部病患於術中皆未使用釘針而改用以(上標 TM)Ligasure或(上標 TM)Plasmakinetic等止血器械，隨著經驗的累積，手術時間也隨之降低。根據我們的經驗顯示，腹腔鏡根除性膀胱切除術不僅可以減少出血，也可以單獨使用四個套管來進行，以減少改變位置引起之方向感紊亂。而使用止血器械來幫助止血，效果與釘針(EndoGIA)類似，且可以大幅減少病患之手術花費，但是其長期之效果仍需要更多之臨床經驗來確認。

關鍵字

腹腔鏡 ； 根除性膀胱切除術 ； 膀胱

並列摘要

OBJECTIVE: A laparoscopic radical cystectomy (LRC) is a challenging, time-consuming procedure often associated with complications. We report our experience with hand-assisted and pure staple-less LRC.
MATERIALS AND METHODS: Between March 2002 and September 2004, 8 patients underwent LRC, and urinary diversions were performed in 5 of these patients. Hand-assisted laparoscopy was performed in 2 patients, while 6 patients underwent pure laparoscopy. In the last 4 cases in the series, we used only 4 ports by omitting the left lower abdominal port. Staples were not used in any of the procedures. Instead, only bipolar cauterization ((superscript TM)Ligasure or (superscript TM)Plasmakinetic) was used for hemostasis. The surgical outcomes were analyzed in a retrospective review of the medical records.
RESULTS: Three patients were male and 5 were female. The mean age was 60 years. The mean operative time for LRC with urinary diversion (cases 1~5) was 10.3 hours, without urinary diversion (case 6) was 5.8 hours, and with a simple LRC plus a nephouretectomy (cases 7 and 8) was 9.5 hours. The average mean blood loss in cases 1~5 was 510 ml, in case 6 was 50 ml, and in cases 7 and 8 was 300 ml. None of the cases required conversion to open surgery, and no major complications occurred during the operations. Pathologic diagnoses included high-grade traditional cell carcinoma and adenocarcinoma.
CONCLUSIONS: In our experience, hand-assisted LRC helped us in shifting to a pure laparoscopic approach. With increasing experience, LRC can be performed using only 4-ports. In addition, the vascular pedicles of the bladder can effectively be controlled without the use of staples.

並列關鍵字

laparoscopy ； radical cystectomy ； urinary bladder