经脐单孔腹腔镜完全腹膜外腹股沟疝修补术95例

Single-incision laparoscopic surgery for totally extraperitoneal herniorrhaphy via umbilical incision:A report of 95 cases

目的总结经脐单孔腹腔镜下完全腹膜外腹股沟疝修补术手术技巧。方法回顾分析2018年10月至2019年6月,宁波大学医学院附属医院开展的95例经脐单孔腹腔镜全腹膜外腹股沟疝修补术(SILS-TEP)的临床资料,总结手术技巧。结果 95例SILS-TEP手术,2例中转为常规三孔TAPP手术。单侧手术时间(66.74±10.95)min。术后发生血清肿3例,脐部切口感染2例,无阴囊血肿、慢性疼痛、补片感染和脐部切口疝,随访期间无复发。主要技巧包括:对常规单孔Port进行改良/造和带吸引电钩有助操作;脐下缘弧形切口有利于隐匿瘢痕;左右手交叉操作;疝囊用电钩分离或分离钳接电后分离。结论熟练掌握单孔条件下的手术技巧及规范操作的TEP是安全可行的。

Objective To summarize the technique of single incision laparoscopic surgery(SILS)via umbilicus for total extraperitoneal inguinal herniorrhaphy(SILS-TEP).Methods 95 cases clinical data of SILS-TEP which were performed in the Affiliated Hospital of Medical School of Ningbo University from October 2018 to June 2019 were analyzed.Results 95 cases underwent SILS-TEP and 2 cases were converted to conventional TAPP.The average unilateral hernia operation time was(66.74±10.95)minutes.There were 3 cases of seroma,2 cases of infection in umbilical incision,no hematoma of scrotum,chronic pain,mesh infection and hernia of umbilical incision,and no recurrence during follow-up.The main techniques included:the improvement/construction of conventional single port and the operation with suction hook;the arc-shaped incision at the lower edge of the umbilicus was conducive to the concealment of scars;the cross operation of left and right hands;the separation of the hernia sac with electric hook or the separation clamp after being electrified.Conclusion It is safe and feasible to operate SILS-TEP under the condition of skilled operation and standard operation.