精索静脈瘤に対する単孔式腹腔鏡下手術の経験

Initial experience of laparoendoscopic single-site surgery for varicocelectomy at our hospital

◆要旨：【目的】当科で施行した単孔式腹腔鏡下精索静脈瘤手術に関して検討する．【背景】対象は2010年1月～12月に施行した10例である．年齢は11～29歳（平均22歳）で，病側は左側9例，両側1例であった．主訴は陰囊痛5例，男性不妊3例，陰囊痛／男性不妊の合併2例であった．【方法】ポートは単孔式ポート（SILS^TM Port）を臍部におき，光学視管は5mmフレキシブルスコープを使用した．鉗子は腹腔鏡下手術用5mm鉗子を使用した．結紮は5mm体内用結紮クリップを使用し，可能な限り内精索動脈を温存した．【結果】術中術後に特に出血などの合併症はなかった．術後疼痛，平均在院日数は3ポートによる腹腔鏡下内精索静脈結紮と変わりはなかった．術後の手術創は3ポートと比較し目立たなかった．【結論】本術式による精索静脈瘤手術は従来の3ポートによる腹腔鏡下手術と同等の結果が期待できるうえ，技術的にも合併症が少なく施行可能であった．また，ポートが臍部だけで完結できるため，整容性に優れた術式であった．

［Purpose］ We reviewed varicocelectomy cases performed by laparoendoscopic single-site surgery （LESS） at our hospital. ［Background］ We performed LESS varicocelectomy in 10 cases in January 2010 to December 2010. Patients were 11 to 29 years old （Ave.22 years old）, 9 cases were on the left side, one case on both sides. There was scrotal pain on five cases, male infertility on three cases, and two cases had both. ［Method］ We used multi access port（SILS^TM Port） to the umbilicus, and using a 5mm flexible scope for optical viewing, 5mm forceps for laparoscopic surgery. All procedures were perfomed for left-sided varicocele. For ligation, we used 5mm metal clip, and preserving the spermatic artery when possible. ［Results］ We did not have any complications intraoperatively nor postoperatively, like bleeding in particular. The operation times and hospital days were similar to the conventional 3 ports laparoscopic varicocelectomy, and postoperative pain and cosmesis was improved. ［Conclusion］ Laparoscopic varicocelectomy with this procedure have nearly the same outcome as anticipated by the three-port laparoscopic surgery and can be performed with even less technical complications. Moreover, it can be completed by using only by the umbilical port resulting in excellent cosmesis. Shorter operative time was thought possible, with further development.