左手用細径鉗子追加単孔式腹腔鏡下胆囊摘出術

Single-incision laparoscopic cholecystectomy with a small caliber forceps via additional 3mm trocar in the right subcostal region

◆要旨：右季肋部から術者左手用の細径鉗子を追加する単孔式腹腔鏡下胆囊摘出術を41例経験した．臍部にマルチチャンネルポートを置き，5mmトロッカーを3本留置して，胆囊底部を臍部ポートからの鉗子で挙上する．右季肋部の3mmトロッカー経由の細径鉗子を術者左手で操作し，頸部を把持する．右手は残りの臍部ポートをワーキングポートとして使用した．手術完遂率は100％で，合併症は臍部切開創感染1例のみであった．また，術中胆道造影のルーチン化が可能であった．本手術は，術者左手の自由度が大きく，通常の腹腔鏡下胆囊摘出術に近似したtriangular formationが得られた．したがって，単孔式手術に比べ手技は容易で安全確実性が高くなり，整容性も劣らない優れた術式と考えられた．

　Forty-one patients underwent transumbilical single-incision laparoscopic cholecystectomy with a small caliber forceps via additional 3mm trocar in the right subcostal region at our department. A grasping forceps via the port of the multichannel port was used to grasp and tract the fundus. The small caliber forceps in the right subcostal region was used to grasp the neck by the operator's left hand. As a result, the completion rate of this procedure was 100％. As for postoperative complications , there was just one umbilical wound infection. Routine intraoperative cholangiography could be perfomed. The movable range of the operator's left hand is much wider than usual transumbilical single-incision laparoscopic cholecystectomy. And the procedure has gained the triangular formation similar to conventional laparoscopic cholecystectomy so that the operation has becomed easier and safer. Furthermore, cosmetic outcome is not thought to be inferior to single-incision laparoscopic surgery.