単孔式腹腔鏡下手術におけるCoaxial Set-upを意識したポートの挿入法

An insertion method of ports with extra care for coaxial set-up using single port laparoscopic surgery

◆要旨：ターゲット臓器に対するcoaxial set-upを意識したポートの挿入法を報告する．臍部直上で2～2.5cmの縦切開を置き，皮下を剝離する．臍中央部の筋膜欠損部からXCELポートをoptical法で腹腔内に挿入する．経5mm×50cm超の30度斜視硬性鏡をターゲットにあわせ腹壁に直線ラインをつける．次にカメラ挿入部でそのラインに垂直にラインを引き，その方向に鉤を引き，ワーキングトロッカーとしてエンドチップカニューレを挿入すると，標的部に向かうカメラのラインを中心とした2等辺3角形が形成されポート間の距離を確保でき，coaxial set-upが可能になる．臍部単孔式手術44例に行った．挿入時間は有意に短くなり，ポート間距離は有意に長く確保できた．この方法は簡便で挿入にかかわるトラブルはなかった．

　We report here an insertion method of a working port toward the target organ with extra care for coaxial set-up. A 2-to 2.5-cm vertical skin incision is made just above the umbilicus and the subcutaneous tissue is stripped. A XCEL port is inserted from the fascia defect at the center of the umbilicus into the abdominal cavity by an optical method, and a 30°-oblique hard scope（5 mm in diameter and 50 cm in length）is inserted toward the target and a straight line is marked on the abdominal wall. Next, a hook is inserted along the line, perpendicular to the straight line at the camera insertion point, and an EndoTIP cannula is inserted toward the hook as a working trocar. Then, an isosceles triangle centered on the line of the camera heading toward the target is formed. This method secures sufficient distance between the port and enables us the coaxial setting. We performed trans-umbilical single incision laparoscopic surgery in 44 patients using this method. The port insertion time was significantly shorter, and the distance between working ports was significantly longer than former method. This method was convenient and there was no trouble related to the insertion.