腹腔镜手术改变了许多手术条件的管理。与开放手术相比,它具有许多优势,如术后疼痛减轻,更快的恢复,更短的住院时间和优秀的美容。自二十年以来,单切口内窥镜手术(SIES)被引入外科界。SIES可能会导致比多口腹腔镜手术更好的术后结果,特别是关于美容结果和疼痛。然而,单切口外科手术伴随着相当多的挑战.
选择了一个由外科医生组成的专家小组,并邀请他们参加关于SIES主题的共识会议的材料准备工作。这是在法兰克福EAES大会期间举行的,2017年6月16日。在共识会议期间提交的材料是基于通过根据预先指定的协议对文献进行系统搜索而确定的证据。小组确定了有关SIES的三个主要主题:(1)一般,(2)器官特异性,(3)新的发展。在每个主题中,已经定义了子类别。根据牛津2011年证据等级对证据进行分级。建议是根据等级标准提出的。
一般来说,单切口内镜手术领域缺乏高水平证据和长期随访。在选定的患者中,单切口入路在围手术期发病率方面似乎是安全有效的.已确定对美容的满意度是单切口入路的主要优势。与传统腹腔镜手术相比,单切口手术后疼痛减轻似乎是一种优势,尽管在整个研究中并未得到一致证明。
考虑到增加的直接成本(设备,仪器和操作时间)的SIES程序和延长的学习曲线,只有在证明了明确的好处之后,才应支持对该程序的更广泛接受。
Laparoscopic surgery changed the management of numerous surgical conditions. It was associated with many advantages over open surgery, such as decreased postoperative pain, faster recovery, shorter hospital stay and excellent cosmesis. Since two decades single-incision endoscopic surgery (SIES) was introduced to the surgical community. SIES could possibly result in even better postoperative outcomes than multi-port laparoscopic surgery, especially concerning cosmetic outcomes and pain. However, the single-incision surgical procedure is associated with quite some challenges.
An expert panel of surgeons has been selected and invited to participate in the preparation of the material for a
consensus meeting on the topic SIES, which was held during the EAES congress in Frankfurt, June 16, 2017. The material presented during the
consensus meeting was based on evidence identified through a systematic search of literature according to a pre-specified protocol. Three main topics with respect to SIES have been identified by the panel: (1) General, (2) Organ specific, (3) New development. Within each of these topics, subcategories have been defined. Evidence was graded according to the Oxford 2011 Levels of Evidence. Recommendations were made according to the GRADE criteria.
In general, there is a lack of high level evidence and a lack of long-term follow-up in the field of single-incision endoscopic surgery. In selected patients, the single-incision approach seems to be safe and effective in terms of perioperative morbidity. Satisfaction with cosmesis has been established to be the main advantage of the single-incision approach. Less pain after single-incision approach compared to conventional laparoscopy seems to be considered an advantage, although it has not been consistently demonstrated across studies.
Considering the increased direct costs (devices, instruments and operating time) of the SIES procedure and the prolonged learning curve, wider acceptance of the procedure should be supported only after demonstration of clear benefits.