背景:单切口腹腔镜手术(SILS)对于良性和恶性结直肠疾病是安全可行的。与多端口腹腔镜手术相比,SILS具有可比或改善的结果,但在骨盆手术时存在技术局限性。为了解决这些限制,我们开发了一种创新的SILS+1方法,该方法使用单个Pfannenstiel切口通过一个额外的脐带端口进入骨盆.我们的目标是比较SILS和SILS+1在下腹部和盆腔结直肠手术中的结果。
方法:回顾一个前瞻性维护的数据库,确定了2009年至2014年接受选择性减孔腹腔镜下腹/盆腔结直肠手术的患者。病例按方法分层:SILS与SILS+1,然后在年龄上匹配1:2,性别,体重指数(BMI),合并症,和程序。人口统计,围手术期,和术后结果变量进行评估.主要结果指标是手术时间,转化率,逗留时间,并发症,发病率,和死亡率。
结果:评估了一百三十二名减少的端口AR/LAR患者-44SILS和88SILS1。两组的年龄相似,性别,BMI,和ASA类。两个队列的主要诊断是憩室炎(90.9%SILS,87.5%SILS+1),主要手术进行了前直肠乙状结肠切除术(86.4%SILS,88.2%SILS+1)。显著更多的SILS+1患者先前进行过腹部手术(p=0.01)。SILS+1的手术时间明显缩短(平均166.6[SD48.4]vs.178.0[SD70.0],p=0.03)。与SILS相比,SILS+1的多端口或开放手术转化率也显著降低(1.1vs.11.4%,p=0.02)。术后,各组的住院时间相似。SILS倾向于更高的并发症和再入院率(NS)。两组均无计划外再手术或死亡。
结论:SILS+1有利于盆腔和下腹部结直肠手术,手术时间短,转化率低。额外的端口改善了可视化和结果,对停留时间没有任何影响,重新接纳,或并发症发生率。
BACKGROUND: Single-incision laparoscopic surgery (SILS) is safe and feasible for benign and malignant colorectal diseases. SILS has comparable or improved outcomes compared to multiport laparoscopy but technical limitations when operating in the pelvis. To address these limitations, we developed an innovative SILS+1 approach using a single Pfannenstiel incision for pelvis access with one additional umbilical port. Our goal was to compare outcomes for SILS and SILS+1 in lower abdominal and pelvic colorectal surgery.
METHODS: Review of a prospectively maintained database identified patients who underwent an elective reduced port laparoscopic lower abdominal/pelvic colorectal procedure from 2009 to 2014. Cases were stratified by approach: SILS versus SILS+1 then matched 1:2 on age, gender, body mass index (BMI), comorbidity, and procedure. Demographic, perioperative, and postoperative outcome variables were evaluated. The main outcome measures were operative time, conversion rate, length of stay, complication, morbidity, and mortality rates.
RESULTS: One hundred thirty-two reduced port AR/LAR patients were evaluated-44 SILS and 88 SILS+1. The groups were similar in age, gender, BMI, and ASA class. The primary diagnosis in both cohorts was diverticulitis (90.9 % SILS, 87.5 % SILS+1), and main procedure performed an anterior rectosigmoidectomy (86.4 % SILS, 88.2 % SILS+1). Significantly more SILS+1 patients had previous abdominal surgery (p = 0.01). The operative time was significantly shorter in SILS+1 (mean 166.6 [SD 48.4] vs. 178.0 [SD 70.0], p = 0.03). The conversion rate to multiport or open surgery was also significantly lower with SILS+1 compared to SILS (1.1 vs. 11.4 %, p = 0.02). Postoperatively, the length of stay across the groups was similar. SILS trended towards higher complication and readmission rates (NS). There were no unplanned reoperations or mortality in either group.
CONCLUSIONS: SILS+1 facilitates pelvic and lower abdominal colorectal surgery, with shorter operative times and lower conversion rates. The additional port improved visualization and outcomes without any impact on length of stay, readmission, or complication rates.