经脐单孔腹腔镜在生殖相关手术的安全性及学习曲线

The safety and learning curve of laparoendoscopic single-site technique in female reproductive related surgery

目的探讨经脐单孔腹腔镜手术(laparoendoscopic single-site surgery,LESS)技术在女性生殖相关手术中应用的安全性,依据手术时间描述短期学习曲线。方法回顾性分析广州医科大学附属第三医院2016年9月至2017年12月由同一手术医师完成的42例LESS的临床资料,患者年龄22~45岁,平均(30.4±4.9)岁;不孕年限1~15年,平均(3.6±3.0)年;体质量指数17.6~31.3 kg/m^2,平均(22.0±3.1)kg/m^2。所有患者均取经脐入路1.5~2.0 cm切口,置入切口保护套及Port,建立气腹后采用单孔腹腔镜设备及专用器械完成女性生殖相关手术。记录术中更改手术方式情况、手术并发症、术中出血量、术后排气时间、术后住院时间等数据,探讨LESS技术的安全性;结合手术时间及手术例数绘制学习曲线。结果全部42例手术均顺利完成,无术中更改手术方式,无穿刺孔渗血、血管损伤等术中并发症。所有病例术后随访1~12个月,暂未发现切口感染、脐疝等术后并发症。手术时间(73.0±26.9)min,术中出血量(4.5±3.2)ml,术后排气时间(1.5±0.6)d,术后住院时间(2.5±1.1)d。观察学习曲线,约25例手术以后,手术时间渐趋平稳。结论 LESS技术在女性生殖相关手术中的应用是安全可行的,掌握该技术需要一定的学习曲线,约在25例手术以后的手术时间渐趋平稳。

Objective To investigate the safety of laparoendoscopic single-site technique in female reproductive related surgery and to describe the short-term learning curve based on the operative time.Methods The clinical data of 42 cases of laparoendoscopic single-site surgery performed by the same surgeon from Sep.2016 to Dec.2017 in the Third Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed.The average age was(30.4±4.9)years old(range,22-45).The mean infertility duration was(3.6±3.0)years(range,1-15 years).The mean BMl was(22.0±3.1)kg/m 2(range,17.6-31.3)kg/m 2.All patients were taken about 1.5-2.0 cm incision through the umbilical access,incision sheath and Port placement,the establishment of pneumoperitoneum after laparoendoscopic single-site equipment and special instrument to complete the female reproductive surgery.To record the change of operation mode,operation complications,intraoperative blood loss,postoperative exhaust time,hospitalization time and other data to explore the safety of laparoendoscopic single-site technique.The learning curve was plotted according to the operation time and the number of cases.Results All 42 cases were successfully completed,no surgical changes in surgery,no bleeding puncture,vascular injury and other intraoperative complications.All patients were followed up for 1-12 months,yet found incision infection,umbilical hernia and other postoperative complications.The average operation time was(73.0±26.9)min,the intraoperative blood loss was(4.5±3.2)ml,the postoperative exhaust time was(1.5±0.6)days and the hospitalization time was(2.5±1.1)days.Observation of learning curve,about 25 cases of surgery,the operation time gradually stable.Conclusions The laparoendoscopic single-site technique in female reproductive related surgery is safe and feasible.To master this technique requires a certain learning curve,and the operation time gradually becomes stable after about 25 cases.