Fundus-first transumbilical single-incision laparoscopic cholecystectomy with a cholangiogram: a feasibility study
Fundus-first transumbilical single-incision laparoscopic cholecystectomy with a cholangiogram: a feasibility study
复制标题
DOI：
10.1007/s00464-010-1240-6
复制
发表时间：
2011-03-01
影响因子：
3.1
通讯作者：
Belgaumkar, A.
中科院分区：
文献类型：
--
作者：
Patel, Ameet G.;Murgatroyd, B.;Belgaumkar, A.
在描述单切口腹腔镜胆囊切除术（SILC）的文献中，出现了越来越多的技术。一种新的手术方法的出现提醒我们，在过去首次引入腹腔镜胆囊切除术时，胆管损伤的增加。在2008年8月至2009年8月期间，20例有症状的胆囊疾病患者接受了SILC，采用完全经上腹部胃底先行的方法，术中胆管造影。前瞻性地收集包括疼痛评分在内的数据，在最初的系列中，中位手术时间为103分钟（范围，55-177分钟），包括两名患者在手术时接受额外手术的时间。19例患者中有18例完成了术中胆管造影。4例患者需要额外的输液港以安全完成手术。术后12小时的平均疼痛评分为2.5分，视觉模拟评分范围为0-10分。无并发症及死亡。根据研究结果，SILC结合术中胆管造影可以安全地采用眼底优先入路。然而，SILC要成为治疗胆囊疾病的首选手术，还需要证据证明其优于腹腔镜胆囊切除术。
An increasing number of techniques are emerging in the literature describing single-incision laparoscopic cholecystectomy (SILC). The advent of a new surgical approach is a reminder of the increase in bile duct injuries in the past when laparoscopic cholecystectomy was first introduced. With this in mind, the authors describe a safe and reproducible approach to SILC.Between August 2008 and August 2009, 20 patients with symptomatic gallbladder disease underwent SILC using a totally transumbilical fundus-first approach with an intraoperative cholangiogram. Data including pain scores were collected prospectively.In this initial series, the median operative time was 103 min (range, 55-177 min), including the time for two patients undergoing additional procedures at the time of surgery. Intraoperative cholangiograms were completed for 18 of 19 patients. Additional ports were required in four patients for safe completion of the procedure. The mean pain score 12 h postoperatively was 2.5 on a visual analogue scale with a range of 0-10. There was no morbidity or mortality.According to the findings, SILC with an intraoperative cholangiogram can be performed safely using a fundus-first approach. However, for SILC to become the operation of choice for the treatment of gallbladder disease, evidence is required to demonstrate its advantage over laparoscopic cholecystectomy.