배꼽만을 통한 단일공법 복강경하 전자궁절제술: 한국최초 임상보고
Single port transumbilical total laparoscopic hysterectomy (TLH): initial experience in Korea
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초록
단일공법수술은 최소 침습수술의 차세대 수술이라고 할 수 있다. 최근 외과, 비뇨기과, 산부인과의 다양한 질환에서 단일공법수술이 시도되고 있으며 국내에도 도입되어 그 영역을 넓혀가고 있다. 전자궁절제술은 부인과에서 가장 많이 시행되는 수술이다. 그러나 단일공법 복강경하 전자궁절제술은 기술적인 어려움 등으로 거의 시행되지 못하였다. 저자는 자궁샘근증, 자궁근종, 우측 난소 장액낭선종을 가진 환자에게 국내 최초로 배꼽만을 통한 단일공법 복강경하 전자궁절제술 및 우측 부속기 절제술을 시도하여 성공하였다. 배꼽 안으로만 절개를 가하여 통로를 만든 후 상처견인기와 수술장갑으로 만들어진 포트 를 장착하고 1개의 내시경과 2개의 수술기구를 삽입하였다. 자궁의 적출과 난소낭종이 있는 우측 부속기의 절제 후에 복강경하 봉합을 하였다. 일반적으로 사용되는 일직선의 구부러지지 않는 수술기구만이 수술에 사용되었다. 모든 조작은 합병증 없이 시행되었다. 수술 후의 합병증도 없었으며 환자에게 수술 흉터를 남기지 않았다. 이에 저자는 국내 최초로 시행되어 만족스러운 결과를 보인 배꼽만을 통한 단일공법 복강경하 전자궁절제술의 임상경험을 보고한다.
Abstract
Single port access surgery can be the next generation of minimally invasive surgery. It has been tried in various diseases of surgery, urology, and gynecology. It was introduced in Korea and its field is widening. Total hysterectomy is the most common operation in gynecology. However, single port total laparoscopic hysterectomy (TLH) had been hardly performed due to technical difficulties. Author has successfully performed single port transumbilical TLH and right adnexectomy in a patient who had adenomyosis, uterine myoma, and right ovarian serous cystadenoma. One laparoscope and 2 instruments were inserted in 3 cannulas of the port that was made up with a wound retractor and a surgical glove. Laparoscopic suturing was done after total hysterectomy and right adnexectomy. During the operation, only commonly used laparoscopic instruments (straight and rigid) were used. All the procedures were completed without any complications and there were neither postoperative complications nor visible scars. Author reports the first single port transumbilical TLH case in Korea that showed satisfying results.
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