当院におけるReduced Port Surgeryの検討

Abstract

Objective: To describe the procedure of two sites laparoscopy using EZ access (EZ access 2-port) and EZ access 2-port using 3 mm port and devices (EZ access 2-port-3 mm), and present the usefulness of these reduced port surgeries. Subjects: From April 2008 through December 2013, we performed 278 cases of EZ access 2-port, 51 cases of EZ access 2-port 3 mm, 52 cases of single site laparoscopy (SSL), and 246 cases of conventional laparoscopy (4-port).Methods: We conducted a retrospective analysis of the following: (1A) a comparative analysis of operative time between SSL and EZ access 2-port for resection of an ovarian tumor: (1B, 1C) a comparative analysis of surgery time and weight of the uterine myomas between conventional laparoscopy and EZ access 2-port on myomectomy: and (1D, 1E) a comparative analysis of operative time and uterine weight between conventional laparoscopy and EZ access 2-port on hysterectomy. In addition, we evaluated: (2A) a comparative analysis of operative time between EZ access 2-port and EZ access 2-port-3 mm on resection of the ovarian tumor: and (2B, 2C) a comparative analysis of operative time and weight of the uterus between EZ access 2-port and EZ access 2-port-3 mm for a hysterectomy. Results: In 1A, there was a significant difference (P = 0.0033) in operative time between SSL and EZ access 2-port for resection of an ovarian tumor. The surgery time of EZ access 2-port was shorter than that of SSL. In 1B and 1C, there was no significant difference in surgery time and weight of the uterine myomas between conventional laparoscopy and EZ access 2-port on myomectomy. In 1D and 1E, there was a significant difference (P = 0.000003) in surgery time between conventional laparoscopy and EZ access 2-port on hysterectomy. The surgery time of EZ access 2-port was shorter than that of conventional laparoscopy. There was no significant difference in uterine weight between conventional laparoscopy and EZ access 2-port on hysterectomy.In 2A, there was no significant difference in operative time between EZ access 2-port and EZ access 2-port-3 mm for resection of an ovarian tumor. In 2B and 2C, there was no significant difference in operative time and uterine weigh between EZ access 2-port and EZ access 2-port-3 mm for a hysterectomy.Conclusions: EZ access 2-port is an extremely useful method of reduced port surgery. The operative time of EZ access 2-port was shorter than that of SSL. The operative quality of EZ access 2-port compared to conventional laparoscopy was maintained. EZ access 2-port-3 mm is less invasive surgery; thus, we favor reduced port surgery via selection of these reduced port procedures.