單孔內視鏡手術之人因工學系統研究與其臨床效益評估研究

Abstract

在過去二十幾年來，我們發現外科手術發生巨大的革新，也就是過去的治療標準”開放式手術”幾乎大部分被腹腔鏡或各種微創手術所取代。特別是最近幾年腹腔鏡手術的概念，隨著手術技術的演化，於是有了創新的單孔內視鏡手術的產生，其概念是希望藉由將對病患之傷害降至最低(僅有單一小傷口)，進而改善病患術後之臨床成效甚至美容效果。而且隨著單孔內視鏡手術演進也實現了無傷口手術(經自然孔道內視鏡手術)的可能與未來性。 目前雖然已有為數不少的臨床文獻證實單孔內視鏡手術的安全性與可行性，但是此一技術先天上的難度是限制大多數外科醫師廣泛接受這手術的主因。深究其因是透過單一傷口來進行內視鏡手術會導致腹腔鏡手術器械的互相干擾以及不利人體工學。因此如何克服這種技術先天上的難度，不管是用新一代的器械或更新的手術技巧，是單孔內視鏡手術被廣泛接受的決定性因素。 在研究一開始，我們專注在如何以符合人體工學的外科技術來克服單孔內視鏡手術先天上的困難。後續，我們會進一步探討如何將此技術應用在各種單孔內視鏡手術上。此外在進一步的研究中，我們也會探討單孔內視鏡手術應用在各種手術適應症與過去腹腔鏡手術成果之優劣比較。

In the past two decades, we found dramatic change of previous gold standard open surgery had been almost replaced by laparoscopic or minimal invasive surgery. Especially in the past few years, the laparoscopic surgery has further evolved into laparoendoscopic single site surgery which further minimized the number of surgical incisions to only one skin incision. In the hope of this evolution could further minimize the surgical trauma to the patients, and further translate into better clinical and cosmetic outcomes. This natural evolution of laparoscopic technique also paves the way to the scarless surgery, the Natural orifice transluminal endoscopic surgery. Although several clinical studies have confirmed the safety and efficacy of laparoendoscopic single site surgery, further wide acceptance of this technique is mainly limited by its inherent single port setup. With its setup, all the surgical instruments and endoscope enter the abdomen through the same single incision, thus instrument triangulation in conventional laparoscopic surgery was lost and followed by instrument conflicts and ergonomic unfriendly. Therefore, before laparoendoscopic single site surgery gaining wide acceptance, the instrument conflicts and ergonomic limitation brought by the single port setup should be overcome by either new generation laparoscopic instruments or refined laparoscopic technique. In the beginning of our studies, we will address in the tricks and principles of surgical techniques to overcome the inherent limitation of laparoendoscopic single site surgery. With these principles and tricks, we can apply the laparoendoscopic single site surgery to various urological indications easily. In addition, we then focused on the clinical outcomes of laparoendoscopic single site surgery in various indications and compared the outcomes of single port surgery to their conventional laparoscopic counterparts.