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首页> 外文期刊>Surgical Endoscopy >Single-trocar cholecystectomy using a flexible endoscope and articulating laparoscopic instruments: a bridge to NOTES or the final form?
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Single-trocar cholecystectomy using a flexible endoscope and articulating laparoscopic instruments: a bridge to NOTES or the final form?

机译：使用柔性内窥镜和铰接式腹腔镜器械进行单针胆囊切除术：通向NOTES还是最终形式？

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INTRODUCTION: NOTES cholecystectomy, may eliminate complications related to abdominal incisions. However, the nonmandatory gastrotomy and its safe closure is the main controversy accompanying this approach. Transvaginal access has minimal closure consequences but the safety of inserting extralong instruments between the intestines and having the angle of approach from below rather than from above is questionable. We conducted a study for performing cholecystectomy using a single laparoscopic trocar. METHODS: The single-trocar cholecystectomy technique was developed on five porcine animal models weighing 35-40 kg each. A 15-mm trocar was used, inserted transumbilicaly. Retraction of the gallbladder was achieved using an endoloop and transabdominal anchoring. Hartman's pouch was manipulated with an endoscopic grasper, which was passed through the working channel of the endoscope, while dissection of the triangle of Callot was performed using articulating laparoscopic instruments. RESULTS: Single-trocar cholecystectomy was successfully performed in four of five porcine models. Average surgery time was 90 min (35-180 min). The technique was modified and improved throughout the study. No intraoperative complications occurred. CONCLUSIONS: Single-trocar cholecystectomy is feasible and offers safe approach to this procedure. We assume that a single incision at the umbilicus generates minimal somatic pain, and achieves excellent cosmetic results. The translation of this technique to human subjects seems straightforward and raises the question of whether NOTES is the preferred technique for cholecystectomy.
机译：简介：注意：进行胆囊切除术可以消除与腹部切口相关的并发症。但是，非强制性胃切除术及其安全关闭是这种方法的主要争议。经阴道的通入具有最小的闭合效果，但在肠之间插入超长器械并具有从下方而不是从上方接近的角度的安全性值得怀疑。我们进行了一项研究，以使用单个腹腔镜套管针进行胆囊切除术。方法：在五个重35-40 kg的猪动物模型上开发了单针胆囊切除术。使用一根15毫米的套管针，经脐插入。使用内环和经腹锚固术可撤回胆囊。用内窥镜抓取器操纵Hartman的囊，该抓取器穿过内窥镜的工作通道，同时使用铰接式腹腔镜器械进行Callot三角形的解剖。结果：在五个猪模型中的四个中，成功完成了单针胆囊切除术。平均手术时间为90分钟（35-180分钟）。在整个研究过程中对技术进行了修改和改进。术中无并发症发生。结论：单针胆囊切除术是可行的，并且为该手术提供了安全的方法。我们假设在脐带的单个切口产生的躯体疼痛最小，并获得了出色的美容效果。将该技术翻译为人类受试者似乎很简单，并提出了NOTES是否是胆囊切除术首选技术的问题。

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