脾門挙上法により術野展開が有用である単孔式腹腔鏡下脾臓摘出術

Single-incision laparoscopic splenectomy : an efficient technique for the hilum exposure

◆要旨：腹腔鏡下脾臓摘出術において，フレキシブルリトラクターによる脾門の挙上は視野の展開や膵尾部の確認，ステイプラーの誘導に有用である．筆者らは血管テープを用いた脾門挙上法を考案し，これを用いることによってリトラクター使用時と同等あるいはそれ以上の術野展開を可能にし，単孔式腹腔鏡下手術による脾臓摘出術（以下，単孔式脾摘術）を安全に行うことができた．単孔式脾摘では，使用する鉗子の数とその可動性に制限があるため，筆者らの考案した脾門挙上法は有用な手技と考え報告する．

　In traditional laparoscopic splenectomy using four or more trocars, a hanging of the splenic hilum using a flexible retractor is an effective technique to obtain good exposure of the pancreatic tail and the splenic hilum. However, in single-incision laparoscopic splenectomy, an innovative and challenging procedure, no trocar is available for the hanging of the spleen since the number of trocar is limited. Herein, in single-incision laparoscopic splenectomy, we invented a surgical technique using a cloth tape to hang the splenic hilum through an extra skin needle hole. A 58-year-old woman with a saccular splenic aneurysm, measuring 2.6×15 mm in diameter at the splenic hilum, underwent single-incision laparoscopic splenectomy. During the operation, this new technique provided excellent exposure of the splenic hilum, the pancreatic tail, splenic artery, splenic vein, and aneurysm. Moreover, it facilitated the introduction of a surgical stapler to the splenic hilum. This technique enabled us to perform single-incision laparoscopic splenectomy safely and it may also allow to reduce the number of trocars even in traditional laparoscopic splenectomy.