単孔式腹腔鏡下胆囊摘出術46例の経験

Single-incision laparoscopic cholecystectomy : an experience of 46 patients in our hospital

◆要旨：当科では炎症のない胆囊良性疾患を適応として単孔式腹腔鏡下胆囊摘出術を46例経験した．当初は臍部約2cmの単一創より3本のトロッカーを挿入して施行していたが，整容性には大変優れるものの小さな創に無理な力がかかり術後の疼痛が強かった．現在はソフトな素材のアクセスポート：SILS^TM port（コヴィディエン社）の導入により腹壁の損傷を最小限とすることが可能となり，術後疼痛も軽減し，より低侵襲な術式となっている．

　腹腔鏡下胆囊摘出術は胆囊摘出術のgold standardであるが，より整容性，低侵襲を追求した単孔式腹腔鏡下胆囊摘出術が注目されている．当科での本術式の改良点，工夫点を概説し，手術成績を報告する．

　We experienced 46 patients with non-inflammatory disease who underwent single-incision laparoscopic cholecystectomy. At first, we inserted three trocars in the abdominal cavity through a single wound about 2-centimeter-long at the umbilical region. The small single wound in the umbilical region was superior cosmetically. However, because of the extra force inflicted on the wound, patients felt sharp pain in the abdominal wall after the operation. Currently, we are able to reduce the damage of the abdominal wall by using access port with a soft material（so-called SILS TM port）Thus the sharp pain is reduced after the operation.

Laparoscopic cholecystectomy is the “gold standard” for gallbladder removal, and the single-incision laparoscopic cholecystectomy receives a lot of attention due to its minimally invasiveness and its cosmetic result. We report a review of this procedure, improvement and surgical result in our hospital.