4歳男児に対するグローブ法による単孔式腹腔鏡下胆囊摘出術の経験

Single incision laparoscopic cholecystectomy with plus one puncture in an infant with cholelithiasis

◆要旨：4歳男児の胆石症に対しグローブ法によるsingle port surgery（SPS）＋plus one punctureで胆囊を摘出しえたので報告する．手術は臍にwound retractorのXSを装着後，グローブを装着し開始した．5mm×3本のポートで手術を行い，カメラは5mmのflexibleタイプを使用した．胆囊底部把持のため2mmのミニラップを右肋弓下より留置した．鉗子操作はクロス法，パラレル法を交互に繰り返し，肝床部より胆囊を剝離後，胆囊動脈，胆囊管をクリッピングした後に切離し，胆囊を体外へ摘出した．手術時間は1時間52分，出血量は少量であった．第3病日に退院した．SPSはflexibleカメラによる独特の視野，クロス法，パラレル法による操作をeye-hand coordinationを駆使し操作空間を認識できれば幼児でも可能である．

Single port surgery （SPS） is an emerging technique that has been increasingly popular for cholecystectomy in the adult age group. We describe the technique of SPS cholecystectomy using the glove technique with plus one puncture in a 4-year-old boy with cholelithiasis. SPS cholecystectomy was performed through a umbilical incision by using a glove port with three 5mm trocars. A flexible 5 mm camera and flexible CambridgeEndo dissector has been applied to create a maximum space in an infantile abdomen to allow surgery. A two mm plus one puncture mini-lap device was introduced from right side abdomen to hold the gallbladder. The gallbladder attachments to the liver were taken down using an electrocautry device and/or laparoscpic coagulation shears. The gallbladder was taken out from the umbilical incision using a surgical bag without complication. Operation time was 112 minutes, and the child was discharged 3 days after surgery without complication. SPS cholecystectomy in an infant using the glove technique seems to be feasible and may become a standard alternative even in children.