经脐入路腹腔镜手术, 是指将腹腔镜器械经脐部套管置入腹腔镜进行手术的技术。脐部皱褶部位切口愈合后, 腹部无可见的瘢痕。随着器械与设备的改进, 此项技术近年得以快速发展, 成为当前微创外科技术的热点。本文介绍了经脐入路腹腔镜手术的历史、现状, 存在问题以及解决方案。该技术目前研究热点一是解决操作难题, 根据其存在的内部冲突、外部冲突, 以及三角关系缺失等问题进行器械与设备的改进;二是不断扩大该技术的应用范围。外科手术的基本目标是取得良好治疗效果, 其次是美观。经脐入路腹腔镜手术是否真正有益于病人, 尚需要符合循证医学原则的研究予以证实。
The fundamental idea of transumbilical endoscopic surgery (TUES) or laparo-endoscopic single site (LESS) surgery is to have all of the working ports entering the abdomen through a single incision, which could have better cosmetic results or less trauma. The history, current status and controversies of TUES are introduced in this article. The hotspot in TUES is to overcome difficulty in manipulation caused by external and internal conflict, and lack of triangulation. The range of TUES procedures is expanding rapidly. However, we should not overlook the safety for slightly improved cosmetic value. The multicenter, randomized and clinical trials are necessary to further elucidate the safety and efficiency of this new technique
[1] Zhu JF.Transumbilical endoscopic surgery:History,present situation and perspectives[J].WJGE,2011,3(6):107-109.
[2] Zhu JF.Scarless endoscopic surgery:NOTES or TUES[J].Surg Endosc,2007,21(10):1898-1899.
[3] Zhu JF,Hu H,Ma YZ,et al.Transumbilical endoscopic surgery:a preliminary clinical report[J].Surg Endosc,2009,23(4):813-817.
[4] Zhu JF,Hu H,Ma YZ,et al.Totally transumbilical endoscopic cholecystectomy without visible abdominal scar using improved instruments[J].Surg Endosc,2009,23(8):1781-1784.
[5] Cuesta MA,Berends F,Veenhof AAFA.The “invisible cholecystectomy”:a transumbilical laparoscopic operation without a scar[J].Surg Endosc,2008,22(5):1211-1213.
[6] Zornig C,Emmermann A,vonWaldenfels HA,et al.Laparoscopic cholecystectomy without visible scar:combined transvaginal and transumbilical approach[J].Endoscopy,2007,39(10):913-915.
[7] Palanivelu C,Rajan PS,Rangarajan M,et al.Transumbilical flexible endoscopic cholecystectomy in humans:first feasibility study using a hybrid technique[J].Endoscopy,2008,40(5):428-431.
[8] Gill IS,Advincula AP,Aron M,et al.Consensus statement of the consortium for laparoendoscopic single-site surgery[J].Surg Endosc,2010,24(4):762-768.
[9] Romanelli JR,Earle DB.Single-port laparoscopic surgery:an overview[J].Surg Endosc,2009,23(7):1419-1427.
[10] Connor S.Sing-port-access cholecystectomy:history should not be allowed to repeat[J].World J Surg,2009,33(5):1020-1021.
[11] Zhu JF.Which term is better:SILS,SPA,LESS,E-NOTES,or TUES[J]. Surg Endosc,2009,23(5):1164-1165.
