单切口免钛夹腹腔镜胆囊切除术

Objective To explore the safety and feasibility of single-incision laparoscopic cholecystectomy without using titanium-clips. Methods Data of 1016 patients(group A) undergoing single-incision laparoscopic cholecystectomy without using titanium-clips were compared to that of 874 patients(group B)undergoing two-port laparoscopic cholecystectomy without using titanium-clips by t test and chi square test for operating time,operative hemorrhage,the length of postoperative hospital stay and postoperative pain.Results In group A,1001 cases were successfully operated on with single-incision laparoscopic cholecystectomy,with conversion to classic four-port laparoscopic cholecystectomy in 15 cases,while 874 cases in group B were operated on with two-port laparoscopic cholecystectomy.There were no bile leakage,biliary tract injury or death in both groups.There were no difference in operating time[(34.5 ±5.2) min vs (32.0±7.4)min,t=0.063,P=0.526],the length of postoperative hospital stay[(3.1±0.8)d vs(3.2±0.7)d,t=1.073,P=0.326]and operative hemorrhage[(56.5±17.8)ml vs (55.2±15.9)ml,t=0.812,P=0.425](P>0.05) between the two groups,but the postoperative pain was less severe in Group A than that in group B (P=0.000<0.05). Conclusions The single-incision laparoscopic cholecystectomy is feasible,safe,less traumatic and more cosmetic.     

经脐入路腹腔镜无疤痕胆囊切除术33例报告

目的:探讨经脐入路腹腔镜无疤痕胆囊切除术的可行性.方法:33例患者均于脐下穿刺5mm Trocar,置入30°腹腔镜,脐上缘做l5 mm切口,穿刺10mm Trocar作为主操作孔,于其右侧穿刺5mm Trocar后拔出Trocar,置入无创抓钳,完成胆囊切除术.结果:33例手术均获成功,无中转传统腹腔镜手术.手术时间...     

单切口免钛夹腹腔镜胆囊切除术

Objective To explore the safety and feasibility of single-incision laparoscopic cholecystectomy without using titanium-clips. Methods Data of 1016 patients(group A) undergoing single-incision laparoscopic cholecystectomy without using titanium-clips were compared to that of 874 patients(group B)undergoing two-port laparoscopic cholecystectomy without using titanium-clips by t test and chi square test for operating time,operative hemorrhage,the length of postoperative hospital stay and postoperative pain.Results In group A,1001 cases were successfully operated on with single-incision laparoscopic cholecystectomy,with conversion to classic four-port laparoscopic cholecystectomy in 15 cases,while 874 cases in group B were operated on with two-port laparoscopic cholecystectomy.There were no bile leakage,biliary tract injury or death in both groups.There were no difference in operating time[(34.5 ±5.2) min vs (32.0±7.4)min,t=0.063,P=0.526],the length of postoperative hospital stay[(3.1±0.8)d vs(3.2±0.7)d,t=1.073,P=0.326]and operative hemorrhage[(56.5±17.8)ml vs (55.2±15.9)ml,t=0.812,P=0.425](P>0.05) between the two groups,but the postoperative pain was less severe in Group A than that in group B (P=0.000<0.05). Conclusions The single-incision laparoscopic cholecystectomy is feasible,safe,less traumatic and more cosmetic.     

单切口免钛夹腹腔镜胆囊切除术

目的 探讨单切口免钛夹腹腔镜胆囊切除术治疗胆囊良性疾病的可行性及安全性.方法 按患者意愿对1890例胆囊良性疾病患者中的1016例采用脐部单切口免钛夹腹腔镜胆囊切除术(单切口组),实际完成1001例,与同期完成的874例两孔法免钛夹腹腔镜胆囊切除术患者进行比较,采用t检验和x2比较两组的手术时间、术中出血量、术后恢复等情况.结果 单切口组1016例仅15例因胆囊壶腹部炎症严重改为传统的四孔法切除,其余1001例均顺利完成单切口下LC术.两孔法组完成腹腔镜胆囊切除术874例.两组均无胆漏、胆道损伤及手术死亡等严重的手术并发症.单切口组与两孔法组的手术时间无差异[(34.5±5.2)min与(32.0±7.4)min,t=0.063,P=0.526]、术中出血量无差异[(56.5±17.8) ml与(55.2±15.9)ml,t=0.812,P=0.425]、术后住院时间无差异[(3.1±0.8)d与(3.2±O.7)d,t=1.073,P=0.326],而单切口组切口疼痛轻于两孔法组(P=0.000).结论 单切口免钛夹腹腔镜胆囊切除术安全性好,创伤更小,更美观.[关健词]胆囊切除术,腹腔镜;单切口;钛夹     

Single-incision laparoscopic cholecystectomy in children: a retrospective comparison with traditional laparoscopic cholecystectomy

Purpose

The natural progression of minimal access surgery is to perform the same technical operation with minimal or no evidence of scarring. In children, small case series of single-incision laparoscopic cholecystectomy suggests that the operation is feasible; however, no comparison has been made to traditional, multiport laparoscopic cholecystectomy in patient safety, outcomes, and cost.

Methods

A retrospective review of consecutive single-incision laparoscopic cholecystectomies in children was performed from January 2009 to November 2010. Demographics and outcome measures were recorded, including operative time, operative costs, length of stay, need for intravenous analgesia, and operative complications. A concurrent group of pediatric patients undergoing traditional, multiport laparoscopic cholecystectomy was used for comparison.

Results

A total of 69 pediatric laparoscopic cholecystectomies were performed from January 2009 to October 2010. Forty-two patients with a mean age of 14.7 years (range, 5.9-18.9 years) underwent attempted single-incision laparoscopic cholecystectomy, and 27 patients with a mean age of 15 years (range, 2.8-19.4 years) underwent multiport laparoscopic cholecystectomy. Mean operative time (68 vs 64.5 minutes; P, not significant [NS]), length of stay (1.45 vs 1.19 days; P, NS), and doses of intravenous analgesia (1.7 vs 2; P, NS) were not significantly different for patients undergoing single-incision or multiport laparoscopic cholecystectomy, respectively. Two patients (5%) undergoing the single-incision approach required 1 additional port be placed to complete the operation. In addition, there was no significant difference in operative costs between the single-incision and multiport approach ($7766 vs $8383; P, NS).

Conclusion

Single-incision laparoscopic cholecystectomy is safe and effective in the pediatric population. It can be performed with the same technical exposure and outcomes as multiport laparoscopy, with the added benefit of little to no scarring and no increase in cost.     

单孔与传统腹腔镜胆囊切除术的比较：随机对照试验的Meta 分析

目的：评价单孔腹腔镜胆囊切除术（SILC）与传统腹腔镜胆囊切除术（CLC）的安全性和有效性。方法：计算机检索各数据库中有关SILC与CLC的前瞻性随机对照试验。检索时限均为建库至2012年11月。按Cochrane系统评价员手册对纳入文献的方法学质量进行评价后,提取数据,采用RevMan 5.1统计软件行Meta分析。结果：筛选后最终纳入17个研究,共1 267例患者,其中SILC组654例,CLC组613例。Meta分析结果显示,手术时间SILC组长于CLC组（WMD=13.02,95%CI=7.95~18.09,P<0.001）;术后切口外观评分和患者满意度评分SILC组优于CLC组（WMD=1.21,95%CI=0.70~1.72,P<0.001;WMD=0.76,95%CI=0.53~1.00,P<0.001）;术后并发症、术后疼痛评分和住院时间两组间差异无统计学意义（RR=1.13,95%CI=0.87~1.48,P=0.35;WMD=0.03,95%CI= -0.82~0.88,P=0.95;WMD=-0.06,95%CI=-0.40~0.28,P=0.73）。结论：对于治疗非复杂性的胆囊良性疾病,SILC是一项安全而有效的手术操作;它具有良好的切口外观和患者满意的优点。     

经脐入路腹壁无疤痕腹腔镜胆囊切除术

目的:探讨经脐入路腹壁无疤痕腹腔镜胆囊切除术的可行性。方法:30例患者均在脐上或下缘做弧形切口,分别穿刺1个10mm、2个5mm Trocar,置入5mm 30°腹腔镜和操作器械,常规行腹腔镜胆囊切除术,最后从10mm Trocar中取出胆囊。结果:30例均用单孔法完成手术。手术时间20~60min,平均30min。术后3~5d出院,无并发症发生,患者痛苦小,康复快。结论:经脐入路单孔腹腔镜胆囊切除术安全可行,可达到腹部无疤痕的效果,但操作难度较大,对于手术开展的初级阶段应慎重选择病例。     

Totally transumbilical endoscopic cholecystectomy without visible abdominal scar using improved instruments

Objective  The major barrier to transumbilical endoscopic surgery is external interference between the instrument handles around the umbilicus. We describe technique of totally transumbilical endoscopic cholecystectomy using improved instruments. Methods  New trocars (5 and 3 mm in diameter, respectively) without proximal seal system on the sleeves were designed for this procedure. The maximum diameters of the trocars were reduced to 8 and 5 mm, respectively. The instruments used in this study were 5 cm longer than commercially available instruments. Ten cases of totally transumbilical cholecystectomy were performed successfully. Results  All the gallbladders were removed successfully without severe bleeding during dissection, except one case of gallbladder wall perforation by cautery. Mean operating time was 62 ± 25 min (range 45–110 min). All patients were satisfied with abdominal cosmetic results, discharged 48 h after the operation, and returned to work within seven postoperative days. Conclusions  External interference between trocars and instruments can be partially avoided by using the improved instruments. Totally transumbilical endoscopic cholecystectomy becomes feasible with this technique.     

无异物腹腔镜胆囊切除术的研究

目的探讨腹腔镜胆囊切除术后可吸收生物夹与金属钛夹留置体内影响的研究。方法对587例患者全部采用电凝闭塞胆囊动脉,胆囊管仅上1枚可吸收生物夹夹闭,术后3个月超声随访生物夹吸收情况。动物实验20只家兔,分为两组每组10只,分为钛夹组和生物夹组。术后3个月CT和动物解剖检查两组情况。结果587例患者手术均获成功。手术时间约8～15min,住院时间3～5d。术后约3个月生物夹完全吸收,远期腹腔无异物存留。动物实验CT检查钛夹组10支肽夹区均可见金属夹且产生伪影干扰,生物夹组无伪影;解剖发现钛夹组纤维增生包裹层较薄,而生物夹组较厚。结论腹腔仅留1枚可吸收的生物夹不仅缩短了手术时间,降低医疗成本,解决了术后患者行MRI、CT和超声等影像学检查产生的干扰,避免了钛钳脱落所引发的各种并发症,效果满意。     

Problems with technical equipment during laparoscopic surgery

Background This study was designed to investigate the incidence of technical equipment problems during laparoscopic procedures. Methods A video-capturing system was used, consisting of an analog video recorder with three camera image inputs and a microphone. Problems with all technical equipment used by the surgical team, such as the insufflator, diathermy apparatus, monitors, light source, camera and camera unit, endoscope, suction devices, and instruments, were registered. Results In total, 30 procedures were randomly videotaped. In 87% (26/30) of the procedures, one or more incidents with technical equipment (49 incidents) or instruments (9 incidents) occurred. In 22 of those incidents (45%) the technical equipment was not correctly positioned or not present at all; in the other 27 (55%), the equipment malfunctioned as a result of a faulty connection (9), a defect (5), or the wrong setting of the equipment (3). In 10 (20%) cases the exact cause of equipment malfunctioning was unclear. Conclusions The incidence of problems with laparoscopic technical equipment is high. To prevent such problems, improvement and standardization of equipment is needed, combined with the incorporation of checklist use before the start of a surgical procedure. Future research should be aimed at development, implementation, and evaluation of these measures into the operating room.     

上腹部无瘢痕腹腔镜胆囊切除术

目的:介绍一种在上腹部不留手术瘢痕的腹腔镜胆囊切除新术式。方法:方法一:沿脐上、下缘各做5mm横行切口,各穿刺5mmTrocar,分别供5mm腹腔镜和操作器械进出,另在右下腹或脐正下方穿刺5mmTrocar,置入直径5mm抓钳用于协助牵引胆囊,用普通腹腔镜器械和超声刀完成胆囊切除;最后将脐部2戳孔合二为一,取出胆囊。方法二:脐部作10mmTrocar供10mm腹腔镜出入,2个5mmTrocar位于左、右下腹部。结果:平均手术时间35min(20～50min),无中转开腹,4例用方法一,3例用方法二。所选病例均未放置引流。无出血、胆漏等并发症发生。术后住院2d。随访1～3个月,下腹部戳孔均愈合良好,脐部看不出手术痕迹。结论:经脐经下腹部入路腹腔镜胆囊切除是可行的,可达到上腹部无手术痕迹的目的。     

2mm无鞘针形器械在隐瘢痕腹腔镜胆囊切除术中的应用:一种无瘢痕手术新思路

目的:探讨隐瘢痕腹腔镜胆囊切除术的手术方法及应用价值。方法:选择2011年1月至2011年6月60例无严重胆囊炎症的胆囊息肉或胆囊结石患者,随机分为2组,新方法组行隐瘢痕腹腔镜胆囊切除术,单孔组行常规单孔腹腔镜胆囊切除术,对比分析两组患者手术时间、术后切口疼痛程度、术后切口满意程度及中转率。结果:新方法组均顺利完成手术;单孔组28例顺利完成手术,2例中转常规腹腔镜胆囊切除术。新方法组与单孔组手术时间平均(14.17±3.51)min和(24.67±4.12)min,新方法组明显优于单孔组(P<0.01);术后切口疼痛程度轻于单孔组,但差异无统计学意义(P>0.05);术后患者对切口满意程度优于单孔组,差异有统计学意义(P<0.01)。两组均无出血、胆漏、胆管损伤等并发症发生。结论:隐瘢痕腹腔镜胆囊切除术安全、可行,术后瘢痕不明显且隐蔽,相对单孔腹腔镜胆囊切除术,手术时间缩短,手术难度及中转率降低,术后患者切口满意度高,为腹腔镜手术的更微创化发展提供了新的可行途径及思路。     

Single-incision laparoscopic surgery for cholecystectomy: an evolving technique

Background  

Laparoscopic techniques have allowed surgeons to perform complicated intraabdominal surgery with minimal trauma. Recent innovators have pioneered the use of single-incision laparoscopic surgery (SILS), which has the potential of further reducing the trauma of surgical access. This may lead to reduced postoperative pain and improved patient cosmesis.     

Single-incision laparoscopic cholecystectomy

Background  

Single-incision laparoscopic surgery (SILS) has been proposed as a minimally invasive technique with the advantages of smaller external scars and reduced pain. Furthermore, usage of the flexible endoscope for SILS in lieu of the standard laparoscope provides distinct visualization advantages. This video shows a single-incision cholecystectomy performed using a single incision placed through the umbilicus.     

腹腔镜胆囊切除手术入路的研究

目的：探讨3 种腹腔镜胆囊切除（LC）手术入路的适用范围。 方法：回顾性分析2009 年1 月—12 月经腹腔镜胆囊切除术治疗150 例胆囊良性疾病行LC 的临床 资料。 结果：150 例腹腔镜胆囊切除术中三孔法46 例,二孔法54 例,经脐入路50 例,3 组患者的手术 成功率、手术时间、术中岀血、术后肠功能恢复情况无差异（均P>0.05）;在术后疼痛、术后住 院天数方面,经脐入路组明显优于其他两组（均P<0.05）。3 组患者出院后随访均无腹痛、黄疸、 胆瘘、岀血、腹壁切口疝等并发症。 结论：3 种手术入路均能安全完成腹腔镜胆囊切除术,不同患者应根据实际情况选用不同入路, 以手术安全为选择标准。     

Single-incision laparoscopic cholecystectomy: a cost comparison

Background  

Single-incision laparoscopic cholecystectomy (SILC) should not cost more or less than traditional laparoscopic cholecystectomy (LC).     

Single-incision laparoscopic cholecystectomy: a systematic review

Background  

Laparoscopic techniques induced a tremendous revolution in surgery of the biliary tract, mainly due to improved results compared with the open approach and secondary because of their cosmetic advantage. A trend toward even more minimally invasive approaches has led to techniques of single-incision and natural orifice laparoscopic surgery. Because the evaluation of single-incision laparoscopic cholecystectomy (SILC) is rather fragmentary by single-institution small patient series, this article intends to examine the success and the risks of the technique, and attempts to determine its potential limitations.