吊り上げ鉤を用いた腹壁全層吊り上げ法による単孔式腹腔鏡下胆囊摘出術

Single-incision laparoscopic cholecystectomy with abdominal wall lifting using two bars

◆要旨：単孔式腹腔鏡下手術は多くの施設で気腹式により行われているが，手術手技や視野展開の制限も少なくない．また専用のポートや屈曲鉗子も高価である．当科では金属性の吊り上げ鉤による腹壁全層吊り上げ法を用い，気腹を行わずに単孔式腹腔鏡下手術を行っている．臍の創より鉤を2本腹腔に挿入し，挙上器を用いて腹壁を全層で吊り上げる．トロッカーを使用せずスコープと2ないし3本の鉗子で手術を行う．通常の腹腔鏡下胆囊摘出術と同じ手術器具を用い，吸引や洗浄，ガーゼの使用も容易である．2009年11月～2010年12月に23例の単孔式腹腔鏡下胆囊摘出術を施行した．平均手術時間は126分で，平均出血量は32ml，術後入院期間は4.5日で術中胆道造影は84％で施行できた．本方法はコストが低く鉗子などの干渉の少ない安定した術式である．

Single-incision laparoscopic cholecystectomy is generally performed with pneumoperitoneum method. However, the operators have some difficulties moving the instruments because both the operating instruments and the laparoscope are introduced through the same incision and on the same axis, and thus, the operator and the assistant often impede the movements of each other. Specific multi-channel port and disposable roticulater instruments are expensive. Twenty three patients underwent laparoscopic single-incision laparoscopic cholecystectomy between November 2009 and December 2010 at our institute with abdominal wall lifting using two bars without pneumoperitoneum. Median operative time was 113 minutes, median blood loss was 45 cc, and median length of post operative stay was 4.5 days. Intraoperative cholangiography was performed in 84.2 %. There were no perioperative complications. All these operations were performed with conventional straight laparascopic incision because the space for instruments was not so limited. Usual laparoscopic suction system and gauze could be used. Abdominal wall lifting using two bars in single-incision laparoscopic cholecystectomy is feasible and provides good cost performance.