単孔式腹腔鏡下虫垂切除術における腹腔内到達経路の工夫―REAL手術―

A new access technique for single incision laparoscopic appendectomy : REAL surgery

◆要旨：当科では単孔式腹腔鏡下虫垂切除術のさらなる整容性の向上を目的として，remote access laparoscopic surgery（以下，REAL手術）を開発した．REAL手術では，臍周囲ではなく恥骨上に約2cmの単孔をおく．これまで，虫垂炎4例に対してREAL手術を行った． 平均手術時間は70分，出血量は少量で合併症を認めず，平均術後在院日数は4.7日であった．創はビキニラインに隠れ，同定できなくなっていた．本術式は整容性に優れており，特に若年女性の虫垂炎における治療選択肢の1つになりうると考えられた．

　We developed remote access laparoscopic （REAL） surgery, to improve the cosmetic advantages in single-port laparoscopic appendectomy. In REAL surgery, a single 2-cm transverse incision was made medially within the pubic hairline area. Instead of the periumbilical area. Four patients with appendicitis underwent REAL surgery. The mean operative time was 70 minutes and intraoperative blood loss was little. There were no postoperative complications and the mean hospital stay was 4.7 days. Outpatient evaluation showed an invisible scar that is concealed by the pubic hair. REAL surgery provides better cosmetic outcome and could be one of the useful therapeutic choices for appendicitis in young women.