Reduced Port Surgery for Laparoscopic Distal Pancreatectomy Using the Transumbilical Approach with Zigzag Incision.
Reduced Port Surgery for Laparoscopic Distal Pancreatectomy Using the Transumbilical Approach with Zigzag Incision.
复制标题
使用锯齿形切口经脐入路进行腹腔镜远端胰腺切除术的减口手术。
DOI：
10.1089/vor.2012.0140
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
Natsugoe S
中科院分区：
文献类型：
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作者：
Maemura K;Shinchi H;Mataki Y;Mori S;Kurahara H;Iino S;Sakoda M;Ueno S;Takao S;Natsugoe S
简介：腹腔镜手术在远端胰腺切除术（DP）中是治疗胰腺疾病患者的一种有效方法，因为它可以减少失血量、住院时间、术后总体并发症和伤口感染的风险，并且不会大幅增加手术时间。此外，单孔腹腔镜手术越来越受欢迎，手术类型也越来越广泛。然而，与传统的腹腔镜检查相比，这种方法可能需要更长的时间才能完成，并且需要先进的技能和专用仪器来弥补三角测量的不足。特别是，Gelport 腹腔镜系统提供了一个灵活、密封的支点，以方便标准器械的三角测量，同时保持微创手术的气腹。由于易于同时进行手辅助手术，外科医生可以安全快速地应对意外出血。该装置已用于各种器官腹腔镜手术。脐带Z字形皮肤切口技术与Gelport腹腔镜系统相结合，作为腹腔镜多种器官手术的有效方法被引入，兼顾了腹腔镜手术技术难度的降低和美容效果。在这段视频（410 秒）中，我们展示了该技术作为腹腔镜 DP 中进行的缩小端口手术的安全程序，且不会产生不良的美容效果。材料和方法：一名 64 岁的女性因胰腺非功能性内分泌肿瘤接受了腹腔镜 DP 治疗。手术过程如下：在脐部标记出锯齿形皮肤切口后，沿该线切开皮肤。然后，通过切口插入Gelport双环伤口牵开器，将筋膜开口的直径扩大至6cm。将 Gelport 锁在伤口牵开环上，然后使用 CO2 对气腹进行充气。另外两个 5 毫米套管针被插入中上部和左下部的疑病症。如果手术区域不足以继续手术，则可使用 5 毫米柔性牵开器通过另一个 5 毫米套管针提起器官。使用标准程序切除胰体和脾脏。解剖脾动脉和静脉后，使用吻合器技术解剖胰腺实质。解剖标本通过脐部切口顺利取出，没有任何额外的切口和脾脏的破坏。手术时间385分钟，失血20mL。术后，脐部伤口缩小至脐底部。结果与结论：我们介绍了一种使用Gelport系统的脐部锯齿形切口的经脐入路，用于腹腔镜DP缩孔手术。尽管与传统方法相比，该手术需要更长的手术时间，但该患者仍然是我们科室经历了15例传统腹腔镜DP病例后的第二例。我们认为，通过重复经验来缩短操作时间并不困难。因此，我们建议使用锯齿形技术创建脐部切口，可以对胰腺疾病进行简单安全的腹腔镜手术。作者没有需要披露的利益冲突或财务关系。视频运行时间：6分钟50秒
Introduction:Laparoscopic surgery in distal pancreatectomy (DP) is as an effective approach for patients with pancreatic disease because of the reduction in the blood loss, length of hospital stay, and risks of overall postoperative complications and wound infection, without a substantial increase in the operating time. Moreover, single-port laparoscopic surgery has become increasingly popular with a widened indication in more types of surgery. However, compared with the conventional laparoscopy, this approach may take longer to complete and requires advanced skills and dedicated instrumentations to compensate for the lack of triangulation. In particular, the Gelport laparoscopic system provides a flexible, airtight fulcrum to facilitate the triangulation of standard instrumentation while maintaining the pneumoperitoneum for a minimally invasive surgery. As it is easy to perform hand-assisted operation at the same time, the surgeon can cope with unexpected bleeding with safe quickly. The device has been used for various organ laparoscopic surgeries. The combination of the umbilical zigzag skin incision technique and the Gelport laparoscopic system was introduced as an effective procedure for laparoscopic surgery to various organs, reconciling the reduction of technical difficulties with the cosmetic outcomes in laparoscopic surgery. In this video (410 seconds), we demonstrate the technique as a safe procedure for reduced port surgery performed in laparoscopic DP, without adverse cosmetic effects.Materials and Methods:A 64-year-old woman underwent laparoscopic DP for pancreatic nonfunctional endocrine tumor. The procedure is described as follows: After marking the umbilical region for a zigzag skin incision, the skin was incised along the line. Then, a Gelport double-ring wound retractor was inserted through the incision, which enlarged the diameter of the fascial opening to 6 cm. The Gelport was latched to the wound retractor ring, and the pneumoperitoneum was then inflated using CO2. Two additional 5-mm trocars were inserted into the upper middle and lower left hypochondria. If the operation field is not enough for continuing the procedure, the 5-mm flexible retractor is useful for lifting the organ through another 5-mm trocar. The pancreatic body and spleen were resected using the standard procedures. After dissection of the splenic artery and vein, the pancreatic parenchyma was dissected using the stapler technique. The dissected specimen was extracted smoothly through the umbilical incision, without any additional incision and destruction of the spleen. The operating time was 385 minutes, and the blood loss was 20 mL. During the postoperative period, the wound in the umbilical region shrank to the bottom of the umbilicus.Results and Conclusions:We introduced a transumbilical approach using the Gelport system with an umbilical zigzag incision for reduced port surgery in laparoscopic DP. Although this procedure took a longer operating time compared to the conventional method, this patient was still a second case for us after experiences of 15 conventional laparoscopic DP cases in our department. We consider that it is not difficult to shorten the operating time by repeating experience. Thus, we suggest that the creation of an umbilical incision using the zigzag technique allows for an easy and safe laparoscopic surgery for pancreatic diseases.The authors have no conflicts of interest or financial ties to disclose.Runtime of video: 6 mins 50 secs