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山东大学学报 (医学版) ›› 2019, Vol. 57 ›› Issue (12): 26-30.doi: 10.6040/j.issn.1671-7554.0.2019.1091

• • 上一篇    

限制单孔腹腔镜技术发展的因素分析

荣风年,赵珊   

  • 发布日期:2022-09-27
  • 通讯作者: 荣风年. E-mail: fnrong@163.com

Factors limiting the development of laparoendoscopic single-site surgery

RONG Fengnian, ZHAO Shan   

  1. Department of Gynaecology, The First Affiliated Hospital of Shandong First Medical University, Jinan 250014, Shandong, China
  • Published:2022-09-27

摘要: 经脐单孔腹腔镜技术不但具有传统腹腔镜手术的优点,还有手术瘢痕隐蔽、手术标本更易于取出等优势,近几年在微创手术领域发展迅速。但是由于手术操作难度较大,特殊学习曲线以及手术适应证等原因导致该手术方式并未广泛应用于临床,本文从医生的观念、手术操作的瓶颈、学习曲线和设备条件、手术适应证的限制、手术潜在的隐患等限制单孔腹腔镜全面开展的因素进行阐述与探讨。

关键词: 单孔腹腔镜手术, 限制因素, 学习曲线

Abstract: A minimally invasive surgery,laparoendoscopicsingle-site surgery(LESS),has gained popularity as it is “scarless” through a single incision. However, the steep learning curve, in-line vision and surgical indications limit its wide acceptance among surgeons.This paper discusses the factors that restrict the development of LESS, such as the concept of doctors, bottleneck of surgical operation, learning curve, surgical instruments, surgical indications, and potential risks of surgery.

Key words: Laparoendoscopic single-site surgery, Limiting factors, Learning curve

中图分类号: 

  • R713
[1] Tarasconi JC. Endoscopic salpingectomy [J]. J Reprod Med, 1981, 262(10):541-545.
[2] Pelosi MA, Pelosi MA 3rd. Laparoscopic hysterectomy with bilateral salpingo-oophorectomy using a single umbilical puncture [J]. N J Med, 1991, 88(10):721-726.
[3] 王丽娜, 张明乐, 杜彦芳, 等. 单孔腹腔镜联合阴道造穴乙状结肠代阴道成形术治疗先天性无阴道患者的可行性研究[J]. 实用妇产科杂志, 2019, 35(4): 302-305. WANG Lina, ZHANG Mingle, DU Yanfang, et al. Feasibility study on transumbilicallicallaparoendoscopicsingle-site surgery combined withvaginal cavitationinsigmoid colon vaginoplasty[J]. Journal of Practical Obstetrics and Gynecology, 2019, 35(4): 302-305.
[4] Lee J, Kim S, Nam EJ, et al. Single-port access versus conventional multi-port access total laparoscopic hysterectomy for very large uterus [J]. Obstet Gynecol Sci, 2015, 58(3):239-245.
[5] Najah H, Malgras B, Dohan A, et al. The role of single-incision laparoscopic peritoneal exploration in the management of patients with peritoneal metastases [J]. Surg Endosc, 2019. doi: 10.1007/s00464-019-06984-8.
[6] Zouari M, Ben Dhaou M, Ammar S, et al. Laparoendoscopic single-site(LESS)surgery in pediatric urology: a 4-year experience [J]. Curr Urol, 2019, 12(3):153-157.
[7] Chung H, Jang TK, Nam SH, et al. Robotic single-site staging operation for early-stage endometrial cancer: initial experience at a single institution [J]. Obstet Gynecol Sci, 2019, 62(3):149-156.
[8] Chen S, Qi X, Chen L, et al. Laparoendoscopic single-site surgery for comprehensive staging of early ovarian cancer [J]. J Minim Invasive Gynecol, 2019, 26(5):806. doi: 10.1016/j.jmig. 2018.09.781.
[9] Demirayak G, Comba C, zdemir A. Laparoendoscopic single-site sentinel lymph node detection in endometrial cancer [J]. J Minim Invasive Gynecol, 2018, 25(5):776.
[10] Iavazzo C, Gkegkes ID. Single-site port robotic-assisted hysterectomy:a systematic review [J]. Arch Gynecol Obstet, 2014, 289(4):725-731.
[11] Paek J, Kim SW, Lee SH, et al. Learning curve and surgical outcome for single-port access total laparoscopic hysterectomy in 100 consecutive cases [J]. Gynecol Obstet Invest, 2011, 72(4): 227-233.
[12] 刘海元, 孙大为, 张俊吉,等. 《妇科单孔腔镜手术技术专家共识》解读[J]. 中华腔镜外科杂志(电子版), 2017,10(1): 1-6.
[13] Song T, Lee Y, Kim ML, et al. Single-port access total laparoscopic hysterectomy for large uterus [J]. Gynecol Obstet Invest, 2012, 75(1): 16-20.
[14] Yada-Hashimoto N, Onoue M, Yoshimi K, et al. Total laparoscopic hysterectomy in patients with previous abdominal surgery [J]. Arch Gynecol Obstet, 2011, 284(6):1467-1471.
[15] Angioni S, Pontis A, Cela V, et al. Surgical technique of endometrioma excision impacts on the ovarian reserve. Single-port access laparoscopy versus multiport access laparoscopy: A case control study [J]. Gynecol Endocrinol, 2015, 31(6):454-457.
[16] Pontis A, Sedda F, Mereu L, et al. Review and meta-analysis of prospective randomized controlled trials(RCTs)comparing laparo-endoscopic single site and multiport laparoscopy in gynecologic operative procedures [J]. Arch Gynecol Obstet, 2016, 294(3):567-577.
[17] Bush AJ, Morris SN, Millham FH, et al. Isaacson, Womens preferences for minimally invasive incisions [J]. J Minim Invasive Gynecol, 2011, 18(5):640-643.
[18] Ichikawa M, Akira S, Mine K, et al. Evaluation of laparoendoscopic single-site gynecologic surgery with a multitrocar access system [J]. J Nippon Med Sch, 2011, 78(4):235-240.
[19] Antoniou SA, Morales-Conde S, Antoniou GA, et al. Single-incision laparoscopic surgery through the umbilicus is associated with a higher incidence of trocar-site hernia than conventional laparoscopy: a meta-analysis of randomized controlled trials [J]. Hernia, 2016, 20(1):1-10.
[20] Inoue S, Ikeda K, Kobayashi K, et al. Patient-reported satisfaction and cosmesis outcomes following laparoscopic adrenalectomy: Laparoendoscopic single-site adrenalectomy vs. conventional laparoscopic adrenalectomy [J]. Can Urol Assoc J, 2014, 8(1-2): 20-25.
[21] Moulton LJ, Jernigan AM, Michener CM. Postoperative Outcomes after Single-port Laparoscopic Removal of Adnexal Masses in Patients Referred to Gynecologic Oncology at a Large Academic Center [J]. J Minim Invasive Gynecol, 2017, 24(7):1136-1144.
[22] Buckley FP 3rd, Vassaur HE, Jupiter DC, et al. Influencing factors for port-site hernias after single-incision laparoscopy [J]. Hernia, 2016, 20(5):729-733.
[23] Julliard O, Hauters P, Possoz J, et al. Incisional hernia after single-incision laparoscopic cholecystectomy: incidence and predictive factors [J]. Surg Endosc, 2016, 30(10):4539-4543.
[24] Gunderson CC, Knight J, Ybanez-Morano J, et al. The risk of umbilical hernia and other complications with laparoendoscopic single-site surgery [J]. J Minim Invasive Gynecol, 2012, 19(1):40-45.
[25] Kliethermes C, Blazek K, Ali K, et al. Postoperative pain after single-site versus multiport hysterectomy [J]. JSLS, 2017, 21(4):1-8.
[26] Hoyer-Srensen C, Vistad I, Ballard K, et al. Is single-port laparoscopy for benign adnexal disease less painful than conventional laparoscopy? A single-center randomized controlled trial [J]. Fertil Steril, 2012, 98(4): 973-979.
[27] Kaouk JH, Autorino R, Kim FJ, et al. Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1076 cases [J]. Eur Urol, 2011, 60(5):998-1005.
[28] Friedman P, Guo XM, Stiller RJ, et al. Carbon Monoxide Exposure During Pregnancy[J]. Obstet Gynecol Surv, 2015,70(11):705-712.
[29] Nezhat C, Seidman DS, Vreman HJ, et al. The risk of carbon monoxide poisoning after prolonged laparoscopic surgery [J]. Obstet Gynecol, 1996, 88(5):771-774.
[30] Fletcher JN, Mew D, DesCôteaux JG. Dissemination of melanoma cells within electrocautery plume [J]. Am J Surg, 1999, 178(1):57-59.
[31] Fader AN, Escobar PF. Laparoendoscopic single-site surgery(LESS)in gynecologic oncology: technique and initial report [J]. Gynecol Oncol, 2009, 114(2): 157-161.
[32] Najah H, Malgras B, Dohan A, et al. The role of single-incision laparoscopic peritoneal exploration in the management of patients with peritoneal metastases[J]. Surg Endosc, 2019. doi: 10.1007/s00464-019-06984-8.
[33] Jennings AJ, Spencer RJ, Hanks L, et al. The feasibility and safety of adopting single-incision laparoscopic surgery into gynecologic oncology practice [J]. J Minim Invasive Gynecol, 2016, 23(3):358-363.
[34] Moulton L, Jernigan AM, Carr C, et al. Single-port laparoscopy in gynecologic oncology: seven years of experience at a single institution [J]. Am J Obstet Gynecol, 2017, 217(5): 610.e1-610.e8.
[35] Kasahara H, Kikuchi I, Otsuka A, etal.Laparoscopic-extracorporeal surgery performed with a fixationdevice for adnexal masses complicating pregnancy: Report of two cases [J].World J Methodol, 2017, 7(4): 148-150.
[36] 张俊吉, 戴毅, 孙大为, 等. 经阴道自然腔道内镜手术全子宫切除12例:可行性和安全性分析[J]. 中华腔镜外科杂志(电子版), 2018, 11(3):153-156.
[37] 王延洲,徐惠成,李宇迪,等.单中心经自然腔道腹膜外骶骨子宫固定术临床研究[J].中华腔镜外科杂志(电子版),2018,11(5):286-289. WANG Yanzhou, XU Huicheng, LI Yudi, et al.Single institutional case series study in extraperitoneal sacral hysteropexy by transvaginal natural orifice transluminal endoscopic surgery[J].Chin J Laparoscopic Surgery(Electronic edition), 2018, 11(5): 286-289.
[38] 郎景和. 推行微创观念发展微创外科[J]. 中国实用妇科与产科杂志, 2007, 23(8): 577-579.
[39] 中国医师协会妇产科分会妇科单孔腹腔镜手术(包括NOTES)专家技术协作组. 中国大陆妇科单孔腹腔镜及NOTES手术的探索发展及现状[J]. 中华腔镜外科杂志(电子版), 2018, 11(1): 1-3.
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