单孔腔镜技术发展带给我们的思考

Development of laparoendoscopic single site surgery:from theory to clinical

经自然孔道内镜外科(natural orifice transluminal endoscopic surgery,NOTES)经过近10年的研究,已经由一个理想中的概念走向初步的临床应用。由于其尚存在诸多较难克服的技术瓶颈,现阶段仍无法广泛开展。经脐单孔腔镜手术是目前最现实可行的"无瘢痕"技术。该技术近年来在国内外进展迅速,但是仍然存在许多亟待改进的方面,包括操作技巧的进步、器械设备的研发和手术观念的提高。该技术的临床应用和适应证的拓展将为NOTES手术提供有益的技术准备,若与内镜相结合,则可发挥各自的优势,使病人得到更为安全、有效、微创的治疗。由此可见,腔镜医生的培养需要辅以内镜技术的培训,这样才能造就技术全面的微创外科医生。

After nearly 10 years research, Natural orifice transluminal endoscopic surgery （NOTES） has become a preliminary clinical application from an idea conception. Because of some limitations of equipments and techniques, NOTES has not been used widely. Based on the conception of ＂NO scar＂, laparoeudoseopic single site surge1T （LESS） is now regarded as a feasible procedure of NOTES. This technique has been rapidly developed in recent years, however, it still need to be improved at some aspects, including surgical skills, instruments and conceptions. The research and application of LESS will provide useful experiences for NOTES. The hybrid minimally invasive approaches, laparoscope combining with flexible endoscope, will demonstrate more safe, effective and less invasive treatment over the traditional operations. Therefore, the young laparoscopists should be given more endoscopic training.