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1.

Background

Single-port laparoscopic surgery has attracted attention in the field of minimally invasive colorectal surgery. We hypothesized that an experienced laparoscopic surgeon could perform single-port surgery for colon cancer eligible for conventional laparoscopic anterior resection. Our aim was to analyze our initial experience and immediate surgical outcomes of single-port anterior resection.

Methods

A total of 37 consecutive patients with presumed sigmoid colonic cancer underwent single-port anterior resection with standard laparoscopic instruments between May 2009 and June 2010. Each operation was performed by one of two experienced colorectal surgeons. A cohort of patients who had undergone conventional laparoscopic surgery (CLS) for the same duration a year earlier (August 2007 to September 2008) was used as a historical control. Patient demographics and perioperative outcomes were analyzed and compared with those of CLS.

Results

There were no significant differences in mean estimated blood loss, mean length of the resection margin, or morbidity between the two groups, but operative time for the single-port group was significantly shorter (118 ± 41 vs 140 ± 42 min; p = 0.017). Single-port laparoscopic surgery was successfully performed in 78.4 % (29/37) of the patients treated in 2010, and CLS was successfully completed in all of the patients treated the previous year (p = 0.000). The main causes of single-port surgery failure were adhesion and tumor location.

Conclusions

Single-port anterior resection is a feasible and safe procedure with immediate outcomes comparable to those of conventional laparoscopy. Further studies are required to determine the feasibility of single-port surgery for colonic tumors outside the sigmoid colon and the long-term outcome.  相似文献   

2.
Shetty GS  You YK  Choi HJ  Na GH  Hong TH  Kim DG 《Surgical endoscopy》2012,26(6):1602-1608

Background

Single-port laparoscopic surgery is slowly but steadily gaining popularity among surgeons performing minimally invasive abdominal surgeries. The aim of the present study is to assess our initial experience with single-port laparoscopic liver resection for hepatocellular carcinoma.

Methods

Between March 2009 and April 2011, 24 patients underwent single-port laparoscopic liver resection for hepatocellular carcinoma. Of these, 13 were laparoscopic segmentectomies, 4 were laparoscopic left lateral sectionectomies, 1 was a right hepatectomy, 1 was a left hepatectomy, and 4 were nonanatomical resections.

Results

Median operating time and blood loss were 205?min (95–545?min) and 500?ml (100–2,500?ml), respectively. Two procedures were converted to multiport laparoscopic hepatectomy due to instrument length limitations, and four were converted to open surgery. There were no serious intraoperative or postoperative complications in this series. Median postoperative stay was 8.5?days (5–16?days).

Conclusions

Although the procedure requires a lot of technical expertise added to the skill of liver surgery, single-port laparoscopic liver resection for hepatocellular carcinoma seems a feasible approach in a variety of well-selected cases. In spite of the demanding nature of the procedure and the requirement of better instrumentation for single-port laparoscopic surgery, the results seem to compare favorably with conventional laparoscopic surgery and open surgery.  相似文献   

3.
目的探讨自制单孔多通道装置在泌尿外科单孔后腹腔镜手术中的应用。方法回顾分析了从2011年6月至2014年5月笔者进行单孔后腹腔镜单纯肾切除术57例、单孔后腹腔镜肾癌根治术35例、单孔后腹腔镜肾上腺切除术36例、单孔后腹腔镜肾囊肿去顶术39例,共167例患者的临床资料。均采用1个切口保护套和1个无粉外科手套组成一个单孔多通道操作装置,使用常规腹腔镜器械进行单孔后腹腔镜手术,术后手术伤口常规予皮内缝合。结果 167例患者均成功进行单孔后腹腔镜手术,无改行常规后腹腔镜手术或开放手术。单孔后腹腔镜单纯肾切除术手术时间(90.0±38.2)分钟,单孔后腹腔镜肾癌根治术手术时间(120.0±33.7)分钟,单孔后腹腔镜肾上腺切除术手术时间(45.0±16.3)分钟,单孔后腹腔镜肾囊肿去顶术手术时间(35.0±15.6)分钟。术中出血量20~200ml,术后无需要输血患者,无重大手术并发症。所有患者均对手术伤口愈合后残留的微小瘢痕感到满意。结论应用自制单孔多通道装置进行泌尿外科单孔后腹腔镜手术安全可行、费用低,减少手术创伤。联合伤口皮内缝合,达到了患者的美观要求,应用前景广阔,可作为有手术伤口美观要求的患者,特别是女性患者行相关手术的首选治疗方法。  相似文献   

4.
Single-port laparoscopic cholecystectomy was developed with the aim of reducing the invasiveness of traditional laparoscopy, diminishing postoperative pain and morbidity. The aim of this prospective study was to assess the feasibility and the efficacy of this new approach. Between April and December 2009, a total of 21 patients underwent single-port laparoscopic cholecystectomy for symptomatic gallbladder stone disease. Single surgeon, elective patient, no preoperative diagnosis of common bile duct stone and no previous upper abdominal surgery were the selection criteria chosen for the study. Attempt to reproduce the standard technique (routine intraoperative cholangiography) was considered. Twenty patients (95.2%) successfully completed single-port surgery, and the median operative time was 65 min (range 40–122). Conversion to standard laparoscopic cholecystectomy was required for one patient (4.8%) for a difficult haemostasis. Intraoperative cholangiography was performed for 14 patients (66.7%). Seven patients (33.3%) were discharged on the same day of the operation; median hospital stay was 1 day (range 1–4). No postoperative complications were observed; one patient was reoperated on the same day of surgery because of unexplained abdominal pain and leucocytosis, but relaparoscopy demonstrated no fluid collection. On the 1st postoperative day, median VAS was 3. Most patients declared to be satisfied with the result of the operation and the resulting scar. Transumbilical single-port access cholecystectomy is feasible using standard laparoscopic instruments. It may reduce morbidity, postoperative pain and may offer cosmetic advantages compared with standard laparoscopic approach. However, presently the procedure may be performed only by surgeons with wide experience with this operation through standard laparoscopic access.  相似文献   

5.

Background

The use of single-port laparoscopy for left-lateral liver sectionectomy (LLLS) has been reported in the literature, but the effectiveness and safety of LLLS has not been validated in randomized, controlled trials. This prospective randomized controlled trial compared the effectiveness and safety of single-port and multi-port laparoscopic LLLS for the surgical treatment of benign liver disease.

Methods

Altogether, 38 patients aged 17–65 years (16 men, 22 women) with benign liver diseases were hospitalized for elective laparoscopic LLLS between January 2010 and December 2012. Patients were randomly assigned to either single-port (n = 19) or multi-port (n = 19) laparoscopic LLLS. Main outcome measures were operative time, volume of intraoperative blood loss, complication rates, and postoperative hospitalization.

Results

Baseline characteristics of the two groups were comparable. Single-port and multi-port laparoscopies were successfully completed in all but one patient (1/19, 5.3 %) who required conversion from a single-port to a multi-port procedure. The two groups had similar mean operative times and volumes of intraoperative blood loss. There were no clinically significant postoperative complications or deaths. The single-port group had a significantly shorter postoperative hospitalization than the multi-port group (2.5 ± 1.7 vs. 4.0 ± 2.1 days; p < 0.05).

Conclusions

Single-port laparoscopic LLLS is a technically feasible, effective, safe alternative to multi-port laparoscopy for the treatment of benign liver diseases in cautiously selected patients.  相似文献   

6.

Purpose

Single-port laparoscopic surgery is more difficult for sigmoid colon and rectal cancers than for right-sided colon cancer. We sought to analyze the feasibility of this procedure for sigmoid colon and rectal cancers and to estimate its difficulty.

Methods

We analyzed prospectively collected data from 63 consecutive patients with sigmoid colon or rectal cancers who underwent single-port laparoscopic surgery at our institution from June 2009 to December 2011. Patient and tumor characteristics, including patients’ pelvic anatomy which was assessed on CT scan imaging, were evaluated to elucidate what factors would affect the difficulty of the procedure and the necessity of using an additional trocar.

Results

Overall, the median operative duration was 190 min and blood loss was 20 ml, with no postoperative complications. The median number of lymph nodes harvested was 17 and the distal margin was 58 mm. The tumor was located significantly closer to the anus in cases in which an additional trocar was required in the right lower quadrant (9.5 vs 18 cm, p?<?0.0001). Procedural difficulty was significantly increased in cases in which the sacral promontory protruded ventrally (odds ratio 0.779 [95 % confidence interval 0.613 to 0.945], p?=?0.0236).

Conclusions

Depending on tumor location and sacral promontory shape, the introduction of an additional trocar might render single-port laparoscopic surgery feasible for sigmoid colon and rectal cancer resection.  相似文献   

7.
Single-port laparoscopic surgery has undergone significant development over the past 5 years. Single port is used in various procedures, including bariatric surgery. The aim of this paper is to describe a surgical technique for gastric bypass with a transumbilical approach (transumbilical gastric bypass—TUGB) with hand-sewn gastrojejunostomy, in selected patients who may be benefited by a better cosmetic result. The procedure begins with a transumbilical vertical incision. We use the GelPOINT single-port device and a 5-mm assistant trocar in the left flank (in the first two cases, a 2-mm subxiphoid liver retractor was used). A gastric pouch is made and calibrated with a 36-Fr bougie. The gastrojejunal anastomosis is performed by hand-sewing in two layers. A Roux-en-Y with a biliary limb of 50 cm and an alimentary limb of 120 cm is performed with a stapler. Three women were subjected to TUGB. The women were aged 28, 31, and 42 years; they had body mass indexes of 40.3, 33, and 38.2; and the operating times were 150, 200, and 150 min, respectively. The first two women underwent a Roux-en-Y gastric bypass (RYGB), and the last woman underwent a RYGB with a resection of the stomach remnant. There were no conversions to open or multitrocar techniques. No complications or deaths occurred. The three patients were satisfied with the cosmetic result. The technique described for TUGB is a feasible procedure for surgeons who have previous experience with the transumbilical approach.  相似文献   

8.

Background

Single-port surgery (LESS) is a new method of minimally invasive laparoscopic urology. These modern methods reduce the tissue trauma of the patient; however, high demands are placed on the surgeon. We report our initial clinical experience.

Material and methods

Eight patients with different pathologies in the abdomen and retroperitoneum (nephrectomy, renal cyst resection) were treated with an abdominal LESS access and two patients with vaginal NOS (natural orifice surgery) access. Previously, we obtained extensive experience with the setup and implementation in animal studies. The port placements were realized by various single-port systems in the paraumbilical region.

Results

All procedures were performed without conversion to an open surgical procedure. Two additional trocars were needed in the first single-port operation. The intra- and postoperative follow-up was uneventful in all patients. The average age of the patients was 58.9 years, the average operating time 131 min, the mean blood loss 70 ml, and the median body mass index 27. The postoperative evaluation of patient satisfaction revealed that all patients were perfectly satisfied.

Conclusions

With appropriate experience and training of the whole team, single-port surgery is a safe and appropriate method for selected renal surgery.  相似文献   

9.

Introduction

New technological advances have enabled the development of single-port laparoscopic surgery. This approach began with cholecystectomy and subsequently with other abdominal surgeries. However, few publications on laparoscopic liver surgery have described the use of complete single-port access. We present our initial experience of a single-port laparoscopic hepatectomy.

Material and methods

Between May 2012 and December 2013, 5 single-port laparoscopic hepatectomies were performed: one for benign disease and four for colorectal liver metastases. The lesions were approached through a 3-5 cm right supraumbilical incision using a single-port access device. All the lesions were located in hepatic segments II or III. Four left lateral sectorectomies and one left hepatectomy were performed.

Results

Median operative time was 135 min. No cases were converted to conventional laparoscopic or open surgery. The oral intake began at 18 h. There were no postoperative complications and no patients required blood transfusion. The median hospital stay was 3 days. The degree of satisfaction was very good in 4 cases and good in one. Patients resumed their normal daily activities at 8 days.

Discussion

Single-port laparoscopic hepatectomy is safe and feasible in selected cases and may reduce surgical aggression and offer better cosmetic results. Comparative studies are needed to determine the real advantages of this approach.  相似文献   

10.

Objective

To assess the possibility of using single-port low anterior resection (LAR) in place of conventional laparoscopic LAR.

Background

Though single-port LS is gradually evolving, the application of single-port LS techniques in LAR have been viewed with skepticism due to technical difficulties.

Methods

Data from patients who had undergone either conventional laparoscopic LAR (n = 49) or single-port LAR (n = 67) for colorectal cancers between March 2006 and March 2013 were analyzed retrospectively.

Results

In single-port LAR group, oncologic outcomes were satisfactory with respect to attainment of lymph nodes (23.4 ± 15.3) and surgical margins (proximal cut margin: 7.1 ± 4.6 cm, distal cut margin: 7.7 ± 5.7 cm). Single-port LAR showed acceptable clinical outcomes manifested by comparable outcomes of post-operative analgesics requirement and length of hospital stay, and by low incidence of post-operative complications (conventional laparoscopic LAR group: 30.6 % vs. single-port LAR group: 14.9 %; P < 0.01). Operative time was comparable between groups (conventional laparoscopic LAR group: 309 ± 93 min vs. single-port LAR group: 277 ± 106 min; P = 0.097). Throughout a series of 67 consecutive single-port LARs, no conversion to multiport or open surgery was occurred.

Conclusion

This study shows that single-port LAR is both safe and feasible for use in resection of colorectal cancer when performed by surgeons who are trained in conventional laparoscopic technique. If further and more extensive studies support our results, then single-port LAR can be an acceptable alternative to conventional laparoscopic LAR for treatment of colorectal cancer.  相似文献   

11.
目的:总结单孔腹腔镜手术诊治子宫切除术后盆腔包块的应用价值及手术方法。方法:回顾分析5年间采用单孔腹腔镜手术诊治53例子宫切除术后盆腔包块患者的临床资料。结果:53例中10例患者行术中冰冻;38例患者获得标本,行常规病理检查。结合探查及病理47例诊断为卵巢瘤样病变,5例为卵巢良性肿瘤(1例畸胎瘤,2例浆液性囊腺瘤,2例粘液性囊腺瘤),1例为恶性肿瘤。41例直接行单孔腹腔镜手术,11例因腹腔粘连严重中转三孔法腹腔镜手术,1例恶性肿瘤患者中转开腹。结论:单孔腹腔镜探查术对子宫切除术后盆腔包块的诊治具有较高的临床应用价值。  相似文献   

12.
经脐单孔腹腔镜阑尾切除术51例报告   总被引:1,自引:1,他引:0  
目的:探讨基层医院行经脐单孔腹腔镜阑尾切除术的可行性,并总结手术经验.方法:回顾分析51例经脐单孔腹腔镜阑尾切除术的手术经验及临床资料.结果:48例成功施行经脐单孔腹腔镜阑尾切除术,手术时间30~90 min,术后无出血、粪漏等并发症发生,恢复良好,治疗及美容效果满意.1例因阑尾根部坏疽穿孔中转开腹,2例因放置引流管增...  相似文献   

13.

Objectives:

Single-port surgery is a rapidly advancing technique in laparoscopic surgery. Currently, there is limited evidence on the learning curve and practicality of performing single-port laparoscopic cholecystectomy.

Methods:

Single-port cholecystectomy was performed on 20 consecutive patients for biliary dyskinesia, symptomatic cholelithiasis, or acute cholecystitis. The Tri-Port was placed in the umbilicus, and a combination of straight and articulating instruments were utilized. Patient characteristics and outcomes were reviewed, and a comparison was made with the prior 20 consecutive laparoscopic cholecystectomies performed using the 3-port technique.

Results:

Characteristics were similar in both groups. The 3-port cholecystectomy had a mean time of 65.7 minutes, and patients had an average body mass index of 28.16. The first single-port cholecystectomy took 160 minutes with sequential improvement to the sixth case of 66 minutes with a mean of 68.2 minutes for the last 15 single-port cases. The average patient body mass index was 30.24. No major complications occurred.

Conclusion:

The largest series to date of single-port cholecystectomy for multiple degrees of biliary disease is presented. This study validates that this technique can be applied effectively and performed in comparable operative times to traditional 3-port cholecystectomy with a learning curve of approximately 5 cases.  相似文献   

14.
目的探讨改良单孔腹腔镜内环口缝扎术治疗小儿鞘膜积液的临床疗效。方法行改良单孔腹腔镜内环口缝扎术治疗小儿鞘膜积液57例,单侧50例,双侧7例。均在单孔腹腔镜下行改良内环口荷包缝合高位结扎术。结果单侧手术时间平均15(12~18)min,双侧手术时间平均25(22~28)min,术中发现隐匿性疝5例,均在直视下一并进行高位结扎术,找到输精管及精索血管并避开。术中无明显出血及血肿,无阴囊积气及其他副损伤,术后平均住院2 d,切口以可吸收线缝合腹膜及皮下1针。术后平均随访12(6~24)个月,无复发,无切口及阴囊感染,无睾丸扭转、睾丸萎缩及发育异常等并发症发生。结论改良单孔腹腔镜内环口缝扎术治疗小儿鞘膜积液具有安全有效、创伤小、无瘢痕、康复快、住院时间短、操作简便、无需特殊器械等优点,值得基层医院推广。  相似文献   

15.
经脐单孔腹腔镜手术在结直肠癌根治术中的应用   总被引:2,自引:1,他引:1  
目的 探讨经脐单孔腹腔镜结直肠癌根治术的可行性及应用前景.方法 报告厦门大学附属中山医院胃肠外科2010年8-9月实施的4例经脐单孔腹腔镜结直肠癌根治术的手术方法和临床效果.结果 本组4例患者中乙状结肠癌3例,直肠癌1例.均顺利完成手术,无中转开腹者.手术平均用时206 min,平均出血量75ml,平均检出淋巴结21枚...  相似文献   

16.

Introduction

The success of laparoscopic surgery is due to the less surgical trauma, including less operative pain, complications and better cosmetics. Objective of our study was to compare in two blind randomized groups of patients, the surgical outcome of total extra-peritoneal (TEP) inguinal hernia repair using either single-port or conventional surgical technique. We will report our interim results in the first group of 50 patients.

Materials and methods

Our study is a prospective, randomized, controlled clinical trial conducted from August 2011 to June 2013. Fifty patients aged between 21 and 80 years undergoing surgery for unilateral inguinal hernia were randomised into two groups: conventional laparoscopic TEP inguinal hernia repair versus single-port TEP repair. Clinical data on patient demographics, surgical technique and findings, postoperative complications and pain scores were collected. Primary endpoint is the postoperative pain while secondary endpoints are recurrence, chronic pain, postoperative hospital stay and complications.

Results

Out of the 50 patients, 26 underwent single-port hernia TEP repair and 24 had conventional 3-port TEP hernia repair after randomization. Mean operative time was 51.7 (±13.4) min in the multiport group and 59.3 (±14.9) min in the single-port group, respectively (P = 0.064). Mean hospital stay was 19.7 (±4.8) h in the conventional group and 22.1 (±4.5) h in the single-port group (P = 0.079). No statistically significant differences were observed between the two groups for postoperative complications, and no recurrence reported at 11 months follow-up. There was no significant difference in the pain scores (visual analog scale) between the two groups at regular intervals post surgery.

Discussion

The outcomes after laparoscopic TEP inguinal hernia repair with a single-port device are comparable to the standard three-port technique.  相似文献   

17.
目的:探讨经脐单孔腹腔镜胆囊切除术的临床可行性。方法:回顾性分析包头医学院第一附属医院普通外科2012年8月—2013年10月期间85例胆囊结石、胆囊息肉行腹腔镜胆囊切除术患者资料,其中41例行经脐单孔腹腔镜胆囊切除术(单孔组),44例行传统三孔法腹腔镜胆囊切除术(三孔组),比较两组的相关临床指标。结果:腹腔镜手术均获成功,无中转开腹;单孔组手术时间明显长于传统组的[(31.73±4.22)min vs.(15.43±1.81)min,P=0.000];两组术中出血量、术后住院时间、住院费用、切口感染率差异均无统计学意义(均P0.05);单孔组术后应用镇痛药物比例明显低于三孔组(7.32%vs.34.09%,P=0.003);两组术后均无胆瘘及其他严重并发症。结论:单孔腹腔镜胆囊切除术与传统三孔法腹腔镜胆囊切除术的治疗效果相同,但单孔腹腔镜手术在微创方面更具有优越性。  相似文献   

18.

Background

In recent years, single-port laparoscopy (SPL) has become an attractive approach for performing surgical procedures. The pitfalls of this approach are technical and financial. Financial concerns are due to the increased cost of dedicated devices and prolonged operating room time. Our aim was to calculate the cost of SPL using a reusable port and instruments in order to evaluate the cost difference between this approach to SPL using the available disposable ports and standard laparoscopy.

Methods

We performed 22 laparoscopic procedures via the SPL approach using a reusable single-port access system and reusable laparoscopic instruments. These included 17 cholecystectomies and five other procedures. Operative time, postoperative length of stay (LOS) and complications were prospectively recorded and were compared with similar data from our SPL database. Student’s t test was used for statistical analysis.

Results

SPL was successfully performed in all cases. Mean operative time for cholecystectomy was 72 min (range 40–116). Postoperative LOS was not changed from our standard protocols and was 1.1 days for cholecystectomy. The postoperative course was within normal limits for all patients and perioperative morbidity was recorded. Both operative time and length of hospital stay were shorter for the 17 patients who underwent cholecystectomy using a reusable port than for the matched previous 17 SPL cholecystectomies we performed (p < 0.001). Prices of disposable SPL instruments and multiport access devices as well as extraction bags from different manufacturers were used to calculate the cost difference. Operating with a reusable port ended up with an average cost savings of US$388 compared with using disposable ports, and US$240 compared with standard laparoscopy.

Conclusion

Single-port laparoscopic surgery is a technically challenging and expensive surgical approach. Financial concerns among others have been advocated against this approach; however, we demonstrate herein that using a reusable port and instruments reduces operative time and overall operative costs, even beyond the cost of standard laparoscopy.  相似文献   

19.

Background

Minimally invasive liver resection is gaining acceptance worldwide. However, the laparoscopic approach often is reserved for small segmental resections due to the fear of significant blood loss. The expansion of laparoscopic liver surgery will depend on the ability of expert surgeons and technological advances to address the management of bleeding and hemostasis with any new approach. The 4½- year experience of a single center performing totally laparoscopic liver resections is presented, with special reference to the techniques the authors have developed to limit blood loss.

Methods

Between 2003 and 2007, 80 patients underwent laparoscopic liver surgery for benign and malignant conditions including colorectal cancer metastases (n = 31), hepatocellular carcinoma (n = 6), neuroendocrine tumor (n = 3), cystic lesion (n = 10), adenoma (n = 8), and focal nodular hyperplasia (n = 7). Totally laparoscopic resections included sectionectomy (n = 27), hemihepatectomy (n = 10), and single/multiple segmentectomies (n = 21). Data for all resections were recorded and analyzed retrospectively to assess blood loss, hospital stay, and morbidity.

Results

The median operative time was 150 min, and the median blood loss was 120 ml, with significantly more blood loss for right-sided transections than for the left liver surgery (821 vs 147 ml; p = 0.012). Four (57%) of seven resections converted to open procedures because of bleeding. No deaths occurred, and only two patients required intraoperative blood transfusions. There were eight complications and one bile leak. The median length of hospital stay was 3 days.

Conclusions

The authors’ experience with 80 totally laparoscopic liver resections over a 4½-year period demonstrates that laparoscopic liver surgery is safe and effective in experienced hands for major resections. An intimate knowledge of the technology and techniques available for preventing and managing significant hemorrhage during laparoscopic liver resection is required for all surgeons performing laparoscopic liver surgery.  相似文献   

20.
Laparoscopic adhesiolysis has been the focus of much recent attention; however, the role of single-port laparoscopic surgery for adhesive small bowel obstruction remains unclear. We report our experience of performing single-port laparoscopic surgery for adhesive small bowel obstruction through a retrospective review of 15 consecutive patients who underwent single-port laparoscopic surgery for single adhesive small bowel obstruction between 2010 and 2012. We analyzed data on patient demographics, operating time, conversion, and surgical morbidity. Surgery was completed successfully without conversion to laparotomy or the need for additional intraoperative ports in 14 patients, but the remaining patient had peritoneal dissemination from colon cancer. The median operative time was 49 (25–148) min, and the estimated blood loss was 19 (2–182) ml. There were no major postoperative complications. We conclude that single-port laparoscopic surgery is a technically feasible approach for selected patients with adhesive small bowel obstruction when preoperative imaging identifies a single adhesive obstruction.  相似文献   

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