右側肝円索を伴う急性胆囊炎に対し単孔式腹腔鏡下胆囊摘出術を施行した2例

A case of single-incision laparoscopic cholecystectomy for a patient with right-sided round ligament

◆要旨：右側肝円索を伴う急性胆囊炎2例に単孔式腹腔鏡下胆囊摘出術を施行したので報告する．症例1は58歳，男性．心窩部痛の精査の結果急性胆囊炎と診断され，単孔式手術が施行された．肝円索と胆囊床が近接しており，肝円索の腹壁への吊り上げで3trocarでも順行性剝離が可能となった．症例2は67歳，男性．同様に急性胆囊炎と診断され手術が施行された．単孔式で開始したが頸部の展開に難渋し，trocarを追加して順行性に剝離し胆囊を摘出した．両症例とも胆囊管認識のために順行性剝離が有効であった．また，単孔式手術の際は肝円索挙上により胆囊の把持挙上が不要となり，挙上鉗子の干渉を減らして順行性剝離が可能であった．

We report two cases of acute cholecystitis with a right-sided round ligament（RL）, treated by single-port laparoscopic cholecystectomy（SPLC）. Case1 : A 58-year-old man with epigastralgia was admitted to our hospital and diagnosed with acute cholecystitis. SPLC was performed. Because the gallbladder（GB） was close to the RL, we were able to dissect it from the liver bed by lifting the RL with only 3 trocars. Case2 : A 67-year-old man was diagnosed with acute cholecystitis and performed cholecystectomy. We started SPLC but additional 3 trocars were inserted intraoperatively because the neck was difficult to see and primarily dissected the GB from the liver bed. In both cases, starting initial dissection from the liver bed was effective to identify the cystic duct. Also in performing SPLC, lifting the RL enabled us to reduce the forceps necessary to lift the GB, as well as interference with other forceps.