大腸癌に対する単孔式腹腔鏡下手術の検討

Single port surgery for colon cancer

◆要旨：【目的】大腸癌に対する単孔式腹腔鏡下手術（single port surgery : 以下，SPS）について報告する．【対象と手技】経験症例は13例．臍部を縦切開後，ここにトロッカー3本をセッティングし，単孔式ですべての手術を行った．基本的に内側アプローチで手技を進め，必要十分なリンパ節郭清ののち，結腸・直腸を十分に授動し，右側結腸癌は機能的端々吻合，左側結腸癌は腹腔内でDST吻合後，臍部閉創を行い手術を終了した．【結果】全例安全に施行された．術式の内訳は回盲部切除3例，右結腸切除1例，右半結腸切除1例，S状結腸切除5例，前方切除2例，人工肛門造設1例．術中偶発症はなく，1例に創部感染を認めたが，その他，術後合併症は認めなかった．【結語】筆者らは，大腸癌に対するSPSを13例経験した．この手技は安全に完遂可能であり整容性にも優れていた．

[Aim] : Transumbilical single port surgery（SPS）has been developed with the aim of further reducing the invasiveness of traditional laparoscopy. We report here the clinical transumbilical SPS for colon cancer. [Patients and Methods] : Between April 2009 and December 2009, 13 patients underwent single port surgery for colon cancer. The umbilical incision was performed, and three 5-mm ports were placed in the umbilical site. The umbilicus was the access point of entry to the abdomen for all the patients. Procedures were mostly carried out using the medial-to-lateral approach. The root of the main mesenteric vascular pedicles was initially dissected with lymphadenectomy（D 2 or D 3）; the mesentery and the diseased segment of the bowel were mobilized from the retroperitoneum. The bowel was transected either intracorporeally with a laparoscopic linear stapler or pulled out through the small incision without bowel transection. Anastomosis was achieved using the double stapling technique or stapled functional end to end anastomosis. [Results]: Transumbilical single incision laparoscopic colectomy（SILC）was feasible with conventional laparoscopic instruments. Of the 13 patients, 12 underwent SILC with lymph node dissection, while one patient underwent stoma creation due to obstructive colon cancer. No intraoperative complications were observed in this series. Postoperatively, there was no mortality. Wound infection was observed in one patient. [Conclusion]: We presented our initial 13 experiences of a single port laparoscopic surgery for colon cancer. Our experience indicates SPS/SILC is feasible for selected patients with colon cancer. This technique contributed to the improvement of patients' cosmetic effects.