細径器具を用いた腹腔鏡下胆嚢摘出術を施行した左側胆嚢の1例

Laparoscopic Cholecystectomy with Miniaturized Instruments for a Left-sided Gallbladder : A Case Report

　左側胆嚢症例に細径器具を用いた腹腔鏡下胆嚢摘出術の1例を経験した．症例は42歳，女性，主訴は心窩部痛．臍上部に12mm，右季肋下に2mmポートを2本挿人し，胆嚢を観察すると胆嚢床は肝円索の左側に位置していた．鮒田式胃壁固定具を用い，3-0ナイロン糸にて肝円索を腹壁に挙上し，固定して視野を確保した．心窩部よりやや左側から2mmポートを1本挿入し4孔式（12-2−2-2）とした．同部位より2mm径，臍上部より10mm径のスコープ・鉗子類を適宜交換して胆嚢を切離し，臍上部創より摘出した．臍上部創のみ縫合閉鎖し，皮膚はテープで固定した．術後経過は良好で第4病日に退院した．

We successfully performed a laparoscopic cholecystectomy with miniaturized instruments for a left-sided gallbladder. A 42-year-old woman who had a two year history of occasional epigastric pain was admitted to our hospital. We used four ports (12mm, 2mm x 3): a 12mm port was placed in the umbilicus, and 2mm ports in the right upper quadrant and the mid-epigastrium. The hepatic falciform ligament was lifted by a 3-0 nylon using a percutaneous gastropexy device to create a good operative view. The cystic duct and artery were di-vided and dissected using 2mm instruments under 10mm laparoscope.