气腹经脐单孔腹腔镜与悬吊式经脐单孔腹腔镜操作技术的比较研究
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摘要
研究背景及目的
经脐单孔腹腔镜操作技术是通过脐部这一人体唯一的瘢痕置入腹腔镜器械,进行腹腔镜手术,相比于经自然腔道外科手术(NOTES)的各种限制,经脐单孔腹腔镜手术是目前创伤最小,美容效果最好的微创手术。但由于CO2气腹存在各种特有并发症,如皮下气肿、气体栓塞、高碳酸血症、心律失常、气胸、纵膈气肿等,特别是对于有心肺功能障碍的病人或年龄较大的病人容易使心功能进一步恶化,悬吊式经脐单孔腹腔镜操作技术应运而生。本研究拟比较悬吊式经脐单孔腹腔镜操作技术与气腹经脐单孔腹腔镜操作技术的术中平均动脉压(MAP)、手术时间、术后恢复时间、SpO2、体重指数、手术费用、术中出血、并发症等方面,讨论悬吊式经脐单孔腹腔镜操作技术的可行性。
研究方法
查阅2008.11-2010.1收入山东大学齐鲁医院普外科由胡三元教授行气腹经脐单孔腹腔镜胆囊切除术和悬吊式经脐单孔腹腔镜胆囊切除术的患者的病案,术前已按照美国ASA标准,选取ASAⅠ、Ⅱ级的患者随机进行气腹经脐单孔腹腔镜手术和悬吊式经脐单孔腹腔镜手术。根据手术方式将患者分为两组：气腹经脐单孔腹腔镜术患者和悬吊式经脐单孔腹腔镜术患者。比较两组患者的术中平均动脉压(MAP)、手术时间、术后恢复时间、SpO2、体重指数、手术费用、术中出血、并发症。使用标准统计软件SPSS15.0进行数据处理,计量资料采用均数±标准差表示,采用完全随机两样本t检验,计数资料采用四格表法χ2检验,不符合正态分布的数据采用非参数检验中的秩和检验(P<0.05有统计学意义)。
结果
2008.11-2010.1年山东大学齐鲁医院普外科接受气腹经脐单孔腹腔镜胆囊切除术和悬吊式经脐单孔腹腔镜胆囊切除术的病人共28例,其中符合ASAⅠ、Ⅱ级标准的共24例。气腹组手术病人建立气腹后前15min内MAP增加明显(P<0.001),悬吊组MAP维持在基线水平；两组病人均属于ASAⅠ、Ⅱ级病人,术中及术后SpO2变化无明显统计学差异两组手术手术时间不具有统计学差异(P>0.05),虽然悬吊组手术野显露较气腹组差,但手术时间基本一致；术后恢复时间不具有统计学差异(P>0.05)；手术费用具有统计学差异(P<0.05),悬吊组手术费用较气腹组手术费用低；术中出血少,无明显统计学差异。
结论及意义
悬吊式经脐单孔腹腔镜手术因不需要二氧化碳气腹的建立,避免了气腹特有的并发症,适用于心肺功能不全者或老年患者。通过此研究,证明悬吊式经脐单孔腹腔镜操作技术在美容效果上与气腹经脐单孔腹腔镜操作技术一样,并且在血流动力学方面更稳定,术后恢复快,避免了一次性的耗材,降低了费用,在经济方面更具有优势。
Background and Objective:The transumbilical single port pneumoperitoneum laparoscopic operation technology is the laparoscopic surgery with laparoscopic instruments through umbilicus.Compared by the natural orifice surgery (NOTES) in a variety of restrictions, the umbilical single port laparoscopic surgery is the minimally invasive surgery with minimal trauma and better cosmetic results。However, there is a variety of CO2 pneumoperitoneum specific complications such as subcutaneous emphysema, gas embolism, hypercapnia, arrhythmia, pneumothorax, pneumomediastinum and so on. Particularly determined to pulmonary dysfunction for older patients with cardiopulmonary dysfunction patients, suspended transumbilical single port laparoscopic operating techniques emerged. This study compared transumbilical single port pneumoperitoneum laparoscopic operation technology and suspended transumbilical single port laparascopic operation technology by the mean arterial pressure (MAP), operation time, recovery time, SpO2, body mass index, hospital costs, blood loss, complications and so on, to discuss the feasibility of the suspended trnsumbilical single port laparoscopic operation technology.
Methods:The documents of the patients who had been admitted into the department of General Surgery of Qilu Hospital, and undergone transumbilical single port pneumoperitoneum laparoscopic and suspended trnsumbilical single port laparoscopic cholecystectomy by professor HU San-Yuan in the period of 2008 to January 2010 were reviewed, ASA standards by the United States before the operation, select ASAⅠ,Ⅱgrade were randomly carried out by single umbilical port pneumoperitoneum laparoscopic surgery and suspended transumbilical single port laparoscopic surgery. The patients were divided into two groups:The single umbilical port pneumoperitoneum laparoscopy patients and suspended transumbilical single port laparoscopic surgery patients. Two groups were compared, the mean arterial pressure (MAP), operation time, recovery time, SpO2, body mass index, hospital costs, blood loss, complications. The statistics is analysed by SPSS 15.0 software with the t test or Wilcoxon test andx2 test between groups (P<0.05).
Results:In the period of November 2008 to January 2010, there were 28 paitents who accept transumbilical single port laparoscopic cholecystectomy and suspended transumbilical single port laparoscopic cholecystectomy, of which comply with ASAⅠ,Ⅱstandard of a total of 24 cases. Pneumoperitoneum group of surgical patients before, after establishing pneumoperitoneum MAP increased significantly within 15min (P＜0.001), suspension group MAP remained at baseline level; two surgical operating time was not statistically different (P> 0.05), although operational exposure is poor in the suspension group, but basically the same operation time; recovery time after surgery was not statistically different (P> 0.05); there is significantly different in hospital costs (P<0.05), suspension group surgical is lower to pneumoperitoneum group; there is no significant difference in body mass index; less bleeding, no significant statistical difference.
Conclusions:Suspended transumbilical single port laparoscopic surgery does not require carbon dioxide for the establishment of pneumoperitoneum, avoid specific complications of pneumoperitoneum for elderly patients with cardiopulmonary dysfunction. Suspended operation by the umbilical single port laparoscopic technique is similar to the insufflation as umbilical single port laparoscopic operation techniques in cosmetic results, and better hemodynamic stability, rapid recovery,also there is advantage in economy by avoiding one-off consumables.
经脐单孔腹腔镜操作技术是通过脐部这一人体唯一的瘢痕置入腹腔镜器械,进行腹腔镜手术,相比于经自然腔道外科手术(NOTES)的各种限制,经脐单孔腹腔镜手术是目前创伤最小,美容效果最好的微创手术。但由于CO2气腹存在各种特有并发症,如皮下气肿、气体栓塞、高碳酸血症、心律失常、气胸、纵膈气肿等,特别是对于有心肺功能障碍的病人或年龄较大的病人容易使心功能进一步恶化,悬吊式经脐单孔腹腔镜操作技术应运而生。本研究拟比较悬吊式经脐单孔腹腔镜操作技术与气腹经脐单孔腹腔镜操作技术的术中平均动脉压(MAP)、手术时间、术后恢复时间、SpO2、体重指数、手术费用、术中出血、并发症等方面,讨论悬吊式经脐单孔腹腔镜操作技术的可行性。
研究方法
查阅2008.11-2010.1收入山东大学齐鲁医院普外科由胡三元教授行气腹经脐单孔腹腔镜胆囊切除术和悬吊式经脐单孔腹腔镜胆囊切除术的患者的病案,术前已按照美国ASA标准,选取ASAⅠ、Ⅱ级的患者随机进行气腹经脐单孔腹腔镜手术和悬吊式经脐单孔腹腔镜手术。根据手术方式将患者分为两组：气腹经脐单孔腹腔镜术患者和悬吊式经脐单孔腹腔镜术患者。比较两组患者的术中平均动脉压(MAP)、手术时间、术后恢复时间、SpO2、体重指数、手术费用、术中出血、并发症。使用标准统计软件SPSS15.0进行数据处理,计量资料采用均数±标准差表示,采用完全随机两样本t检验,计数资料采用四格表法χ2检验,不符合正态分布的数据采用非参数检验中的秩和检验(P<0.05有统计学意义)。
结果
2008.11-2010.1年山东大学齐鲁医院普外科接受气腹经脐单孔腹腔镜胆囊切除术和悬吊式经脐单孔腹腔镜胆囊切除术的病人共28例,其中符合ASAⅠ、Ⅱ级标准的共24例。气腹组手术病人建立气腹后前15min内MAP增加明显(P<0.001),悬吊组MAP维持在基线水平；两组病人均属于ASAⅠ、Ⅱ级病人,术中及术后SpO2变化无明显统计学差异两组手术手术时间不具有统计学差异(P>0.05),虽然悬吊组手术野显露较气腹组差,但手术时间基本一致；术后恢复时间不具有统计学差异(P>0.05)；手术费用具有统计学差异(P<0.05),悬吊组手术费用较气腹组手术费用低；术中出血少,无明显统计学差异。
结论及意义
悬吊式经脐单孔腹腔镜手术因不需要二氧化碳气腹的建立,避免了气腹特有的并发症,适用于心肺功能不全者或老年患者。通过此研究,证明悬吊式经脐单孔腹腔镜操作技术在美容效果上与气腹经脐单孔腹腔镜操作技术一样,并且在血流动力学方面更稳定,术后恢复快,避免了一次性的耗材,降低了费用,在经济方面更具有优势。
Background and Objective:The transumbilical single port pneumoperitoneum laparoscopic operation technology is the laparoscopic surgery with laparoscopic instruments through umbilicus.Compared by the natural orifice surgery (NOTES) in a variety of restrictions, the umbilical single port laparoscopic surgery is the minimally invasive surgery with minimal trauma and better cosmetic results。However, there is a variety of CO2 pneumoperitoneum specific complications such as subcutaneous emphysema, gas embolism, hypercapnia, arrhythmia, pneumothorax, pneumomediastinum and so on. Particularly determined to pulmonary dysfunction for older patients with cardiopulmonary dysfunction patients, suspended transumbilical single port laparoscopic operating techniques emerged. This study compared transumbilical single port pneumoperitoneum laparoscopic operation technology and suspended transumbilical single port laparascopic operation technology by the mean arterial pressure (MAP), operation time, recovery time, SpO2, body mass index, hospital costs, blood loss, complications and so on, to discuss the feasibility of the suspended trnsumbilical single port laparoscopic operation technology.
Methods:The documents of the patients who had been admitted into the department of General Surgery of Qilu Hospital, and undergone transumbilical single port pneumoperitoneum laparoscopic and suspended trnsumbilical single port laparoscopic cholecystectomy by professor HU San-Yuan in the period of 2008 to January 2010 were reviewed, ASA standards by the United States before the operation, select ASAⅠ,Ⅱgrade were randomly carried out by single umbilical port pneumoperitoneum laparoscopic surgery and suspended transumbilical single port laparoscopic surgery. The patients were divided into two groups:The single umbilical port pneumoperitoneum laparoscopy patients and suspended transumbilical single port laparoscopic surgery patients. Two groups were compared, the mean arterial pressure (MAP), operation time, recovery time, SpO2, body mass index, hospital costs, blood loss, complications. The statistics is analysed by SPSS 15.0 software with the t test or Wilcoxon test andx2 test between groups (P<0.05).
Results:In the period of November 2008 to January 2010, there were 28 paitents who accept transumbilical single port laparoscopic cholecystectomy and suspended transumbilical single port laparoscopic cholecystectomy, of which comply with ASAⅠ,Ⅱstandard of a total of 24 cases. Pneumoperitoneum group of surgical patients before, after establishing pneumoperitoneum MAP increased significantly within 15min (P＜0.001), suspension group MAP remained at baseline level; two surgical operating time was not statistically different (P> 0.05), although operational exposure is poor in the suspension group, but basically the same operation time; recovery time after surgery was not statistically different (P> 0.05); there is significantly different in hospital costs (P<0.05), suspension group surgical is lower to pneumoperitoneum group; there is no significant difference in body mass index; less bleeding, no significant statistical difference.
Conclusions:Suspended transumbilical single port laparoscopic surgery does not require carbon dioxide for the establishment of pneumoperitoneum, avoid specific complications of pneumoperitoneum for elderly patients with cardiopulmonary dysfunction. Suspended operation by the umbilical single port laparoscopic technique is similar to the insufflation as umbilical single port laparoscopic operation techniques in cosmetic results, and better hemodynamic stability, rapid recovery,also there is advantage in economy by avoiding one-off consumables.
引文
1. Wilk PJ.Method for use in intra-abdominal surgery. United States patent US 5297536,1994:29.
2. Edmonson JM. History of the instruments for gastrointestinal
3. endoscopy.Gastrointest endosc,1991,37(suppl):27-56.
4. Joris JL,Noirot DP,Legrand MJ,et al.Hemodynamic changes during laparoscopic cholecystectomy.Anesth Analg 1993,76:1067-1071.
5. Sharma KC,Brandsletter RD,Brensilver JM,Jung LD.Cardiopulmonary physiology and pathophysiology as a consequence of laparoscopic surgery.Chest, 1996,100:810-5.
6. Sharma KC,Kabinoff G,Ducheine Y,et al.Laparoscopic surgery and its potential for medical complications.Heart Lung,1997,26:52-64.
7. Bardoczky GI,Engelman E,Levarlet M,Simon P.Ventilatory effects of pneumoperi to neum monitored with continuous spirometry.Anaesthesia,1993, 49:309-311.
8. Fahy BG,Bamas GM,Flowers JL,et al.The effects of increased abdominal pressure on lung and chest wall mechanics during laparoscopic surgery.Anesth Analg,1995,81:744-750.
9. Don HF,Robson JG.The mechanics of the respiratory system during anesthesia:the effects of atropine and carbon dioxide.Anesthesiology,1965, 26:168-178.
10. Sly PD,Bates JHT,Kochi T,et al.Frequency-dependent effects of hypercapnia on respiratory mechanics of cats.J Appl Physiol,1987,62:444-450.
11. Hasel R, Arora SK, Hickey DR.Intraoperative complications of laparoscopic cholecystectomy.Can J Anaesth,1993,40:459-464.
12. Nagai H.A new method of laparoscopic cholecystectomy:an abdominal wall lifting technique without pneumoperitoneum[J]. Surgical Laparoscopy & Endoscopy,1991,7(2):126-1281.
13. Kitano S,Tomikawa M,Iso Y,et al. A safe and simple method to maintain a clear field of vision during laparoscopic cholecystectomy.Surg Endosc,1992, 6:197-198.
14. Gazayerli MM.The Gazayerli endoscopic retractor model 1.Surg Laparosc Endosc,1991,1:98-100.
15. Kitano S,Iso Y,Tomikawa M,et al.A prospective randomized trial comparing pneumopeitoneum and U-shaped retractor elevation for laparoscopic cholecystectomy.Surg Endosc,1993,7:311-314.
16. Anna-Maria Koivusalo,Ilmo Kellokumpu,Mika Scheinin.A Comparison of Gasless Mechanical and Conventional Carbon Dioxide Pneumoperitoneum Methods for Laparoscopic Cholecystectomy.Anesth Analg,1998,86:153-8.
17. Smith R,Fry W,Tsio E,et al.Gasless laparoscopu and conventional instruments.Arch Surg,1993,128:1102-7.
18. Alberti A,Giannetto G,Littori F,et al.Abdominal compartment syndrome in video laparoscopic surgery. Etiopathogenetic aspects,physiopathology and personal experience[J].Chit Ital,1998,50(2-4):35-42.
19. Ivankovich AD.Miletich DJ,Albrecht RF,et al,Cardiovascular effects of intraperitoneal insufflation with carbon dioxide and nitrous oxide in the dog.Anesthesiology,1975,42:281-287.
20. Drummond GB,Martin LVH.Pressure-volume relationships iin the lung during laparoscopy.Br J Anaesth,1978,50:261-269.
21. Wahba RWM,Beique F,Kleiman SJ.Cardiopumonary function and laparoscopic cholecystectomy.Can J A naesth,1995,42:51-63.
22. Bardoczky GI,Engelman E,Levalet M,et al.Ventilatory effects of pneumoperitoneum monitored with continuous spirometry.Anaesthesia,1993, 48:309-311.
23. Dumont L,Matty M,Mardirosoff C,et al.Changes in pulmonary mechanics during laparoscopic gastroplasty in morbidly obese patients.Acta Anaesthesiol Scand, 1997,41:408-413.
24. Purinate GD,Singh H.Ventilatory effects of laparoscopy under general
anaesthesia.Br J Anaesth,1992,68:211-213.
25. Wittgen CM,Andrus CH, Fitzgerald SD,et al.Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy.Arch Surg,1991, 126:997-1001.
26. Fahy BG,Barnas GM,Nagle SE, et al.Changes in lung and chest wall properties and abdominal insufflation of carbon dioxide are immediately reversible.Anesth Analg,1996,82:601-605.
27. Navarra G, Pozza E, Occhionorelli S, et al. One-wound laparoscopic cholecystectomy[J]. Br J Surg,1997,84(5):695.
28. Rao PP, Bhagwt S M, RaneA, et al. The feasibility of single port laparoscopic cholecystectomy:a pilot study of 20 cases[J]. HPB(Oxford),2008,10(5): 336-340.
29. Tacchino R, GrecoF, Matera D. Single incision laparoscopic cholecystectomy: surgery without a visible scar[J]. Surg Endosc,2009,23(4):896-899.
30. Kaouk JH, Haber GP, Goel RK, et al. Single-port laparoscopic surgery in urology: Initial experience[J]. Urology,2008,71(1):3-6.
31. Kaouk JH, Palmer JS. Single-port laparoscopic surgery: initial experience in children for varicocelectomy[J]. BJU Int,2008,102(1):97-99
32. Remzi FH. Kirat HT. Kaouk JH, et al. Single-port laparoscopy in colorectal surgery[J]. Colorectal Dis,2008,10(8):823-826.
33. Rao PP, Bhagwat SM, Rane A, et al. The feasibility of single port laparoscopic cholecystectomy:a pilot study of 20 eases[J]. HPB(Oxford),2008,10(5): 336-340.
34. Desai MM, Aron M, Canes D, et al. Single-Port Transvesical Simple Prostatectomy:Initial Clinical Report[J]. Urology,2008,72(5):960-965.
35. Rane A, Rao P, Rao P. Single-port-access nephrectomy and other laparoscopic urologic procedures using a novel laparoscopic port (R-Port)[J]. Urology,2008, 72(2):260-263.
36. Desai MM, Rao PP, Aron M, et al. Scarless single port transumbilical nephrectomy and pyeloplasty:first clinical report[J]. BJU Int,2008,101(1): 83-88.
37. Merchant AM, Cook MW, White BC, et al. Transumbilical Gelport Access
Technique for Performing Single Incision Laparoscopic Surgery (SILS)[J]. J Gastrointest Surg,2009,13(1):159-162.
38. Ponsky LE, Cherullo EE, Sawyer M, et al. Single access site laparoscopic radical nephrectomy: Initial clinical experience[J]. J Endourol,2008,22(4):663-665.
39. CanesD,DesaiMM,AronM, et al. Transumbilical single-port surgery:Evolution and current status [J]. Euro Urol,2008,54 (5):1020-1029.
40. Rao PP, Bhagwt S M, RaneA, et al. The feasibility of single port laparoscopic cholecystectomy:a pilot study of 20 cases[J]. HPB(Oxford),2008,10(5): 336-340.
41.张光永,胡三元,李峰.经脐单孔腹腔镜胆囊切除术[J].腹腔镜外科杂志,2009,14(1)：18-20.
1. Semm K. Atlas of gynecologic laparoscopy and hysteroscopy.Philade-Lphia, W.B.Saunders,1977.
2. Edmonson JM. History of the instruments for gastrointestinal endoscopy. Gastrointest endosc,1991,37(suppl):27-56.
3. Belt AE,Charnock DA. The cystoscope and its use.In:Cabot H,ed.Modern
4. Urology.Philadephia:Lea & Febiger,1936:15-50.
5. Gunning JE. The history of laparoscopy. J Repord Med 1974,12:222-226
6. Kelling G.Ueber oesophagoskopie, gastroskopie und kolioskopie.Munch Med Wochenschr,1902,21-24.
7. Ott D. Illumination of the abdomen (ventroscopia).J Akush Zhensk Boliez 1901,15:1045-1049.
8. Jacobaeus HC. Ueber die moglichkeit die zystoskopie bei untersuchung Seroser hohlungen anzuwenden. Munch Med Wochenschr,1910,57:2090-2092.
9. Kalk H. Erfarungen mit der laparoskopie. Z Klin Med,1929,111:303-348.
10. Orndoff BH.The peritoneoscope in diagnosis of diseases of the abdomen. J Radiol,1920,1:307-325.
11. Veress J.Neues instrument zur ausfurung von brust-oderbauch-punktionen und pneumothoraxbehandlung. Dtsch Med Wochenschr,1939,64:1480-1481.
12. Anderson JR, Dockerty MB, Waugh JM.Peritoneoscopy:an evaluation of Examinations.Proc Mayo Clin,1950,25:601-605.
13. Palmer R.Instrumentation et technique de la coelioscopie gynecologique. Gynecol Obstet,1947,19:261-275.
14. Frangenheim H. History of endoscopy.In:Gordon AG,Lewis BV ed.Gynecol-Ogical endoscopy.London:Chapman& Hall,1988:1.1-1.5.
15. Marlow J.History of laparoscopy,optics,fiberoptics and instrumentation.Clin Obstet Gynecol,1976,19:261-275.
16. Hasson HM.Open laparoscopy vs closed laparoscopy:a comparison of complication rates.Adv Plan Prevent,1978,13:41-50.
17. Davis JG.Filipi CJ.A history of endoscopic surgery. In:Arregui ME,Fitzgibbons RJ,Katkhouda N,et al.,ed.Principles of laparoscopic surgery-basic and advanced techniques.New York:Springer-Verlag.1995:3-20.
18. Berci G. Laparoscopy in general surgery.In:Berci G,ed.Endoscopy.New York:Appleton Century Croft,1976:382-401.
19. Litynski GS.Highlights in the history of laparoscopy. Frankfurt:BBernert Verlag,1996.
20. Schreiber JH.Early experience with laparoscopic appendectomy in women. Surg Endosc,1987,1:211-216.
21. Reddick EJ,Olsen DO,Daniel JF,et al.Laparoscopic laser cholecystectomy.Laser Med Surg Adv,1989,7:38-40.
22. Katkhouda N,Mouiel J.A new technique of surgical treatment of chronic duodenal ulcer without laparotomy by videocoeliscopy.Am J Surg,1991, 161:361-364.
23. Zucker KA, Bailey RW.Laparoscopic truncal and selective vagotomy for intractable ulcer disease.Semin Gastrointest Dis,1994,5:128-139.
24. Petelin JB.Laparoscopic approach to common duct pathology.Surg Laparosc Endosc,1991,1:33-41.
25. Carroll B,Chandra M,Pappioannou T,et al.Biliary lithotripsy as an adjunct to laparoscopic common bile duct stone extraction.Surg Endosc,1993,7:356-359.
26. Hunter JG,Trus TL,Brauum GD,et al.A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease.Ann Surg,1996 223:673-685.
27. Nathanson LK,Shimi S,Cuschieri A.A sutured laparoscopic cholecystojejunostomy evolved in an animal model. J R Coll Surg Edinb,1992, 37:215-220.
28. Goh P,Tekant Y,Issac J, et al.The technique of laparoscopic Billroth
Ⅱ gastrectomy.Surg Laparosc Endosc,1992,2:258-260.
29. Clayman RV,Kavoussi LR,Soper NJ,et al.Laparoscopic nephrectomy:initial case report .J Urol,1991,146:278-282.
30. Zornig C,Emmermann A,Von Waldenfels HA,ed al.Laparoscopic cholecystectomy without visible scar:combined transvaginal and transumbilical approach[J].Endocopy,2007,39(10):913-915.
31. Nagai HA.New method of laparoscopic cholocystecnomy;an abdominal wall lifting technique without periomoperitoneum.SLE,1991,7:126-128.
32. Ivankovich AD.Miletich DJ,Albrecht RF,et al,Cardiovascular effects of intraperitoneal insufflation with carbon dioxide and nitrous oxide in the dog.Anesthesiology,1975,42:281-287.
33. David G. Whalley,Samuel A.Irefin.Laparoscopic surgery of anesthesia:surgical laparoscopy,2005,2:12-26.
34. Gannedahl P,Odeberg S,Brodin L,et al.Effects of posture and pneumoperitoneum during anaesthesia on the indices of left ventricular filling. Acta Anaesthesiol Scand 1996,40:160-166.
35. Dorsay DA,Greene FL,Baysinger CL.Hemodynamic changes during laparoscopic cholecystectomy monitored with transesophageal echocardiography.Surg Endosc,1995,9:128-134.
36. Harris SN,Ballantyne GH,Luther MA,et al.Alterations of cardiovascular performance during laparoscopic colectomyLa combined hemodynamic and echocardiographic analysis.Anesth Analg,1996,83:482-487.
37. Joris JL,Noirot DP,Legrand MJ,et al.Hemodynamic changes during laparoscopic cholecystectomy.Anesth Analg,1993,76:1067-1071.
38. Kashtan J,Green JF,Parsons EQ,et al.Hemodynamic effects of increased abdominal pressure.J Surg Res,1981,30:249-255.
39. Dhoste K,Lacoste L,Karayan J,et al.Haemodynamic and ventilatory changes during laparoscopic cholecystectomy in elderly ASA III patients.Can J Anaesth, 1996,43:783-788.
40. Cullen DJ,Eger El.Cardiovascular effects of carbon dioxide in
man.Anesthesiology,1974,41:345-349.
41. Sharma KC,Kabinoff G,Ducheine Y,et al.Laparoscopic surgery and its potential for medical complications.Heart Lung,1997,26:52-64.
42. Fujii Y,Tanaka H,Tsuruokat S,et al.Middle cerebral arterial blood flow velocity increases during laparoscopic cholecystectomy.Anesth Analg,1994,78:80-83.
43. Morison CH,Riggs JRA.Cardiovascular collapse in laparoscopy.Can Med Assoc J,1974,111:433-437.
44. Yacoub OF,Cardona I,Coveller LA,et al.Carbon dioxide embolism during laparoscopy.Anesthesiology,1982,57:533-535.
45. Root B,Levy MN,Pollack S,et al.Gas embolismdeath after laparoscopy delayed by "trapping" in portal circulation.Anesth Analg,1978,57:232-237.
46. McGrath BJ,Zimmerman JE,Williams JF,et al. Carbon dioxide embolism treated with hyperbaric oxygen.Can J Anaesth,1989,36:585-589.
47. Drummond GB,Martin LVH.Pressure-volume relationships iin the lung during laparoscopy.Br J Anaesth,1978,50:261-269.
48. Wahba RWM,Beique F,Kleiman SJ.Cardiopumonary function and laparoscopic cholecystectomy.Can J A naesth,1995,42:51-63.
49. Bardoczky GI,Engelman E,Levalet M,et al.Ventilatory effects of pneumoperitoneum monitored with continuous spirometry.Anaesthesia,1993, 48:309-311.
50. Dumont L,Matty M,Mardirosoff C,et al.Changes in pulmonary mechanics during laparoscopic gastroplasty in morbidly obese patients.Acta Anaesthesiol Scand, 1997,41:408-413.
51. Purinate GD,Singh H.Ventilatory effects of laparoscopy under general anaesthesia.Br J Anaesth,1992,68:211-213.
52. Wittgen CM,Andrus CH, Fitzgerald SD,et al.Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy.Arch Surg,1991, 126:997-1001.
53. Fahy BG,Barnas GM,Nagle SE, et al.Changes in lung and chest wall properties and abdominal insufflation of carbon dioxide are immediately reversible.Anesth
Analg,1996,82:601-605.
54. Hasel R, Arora SK, Hickey DR.Intraoperative complications of laparoscopic cholecystectomy.Can J Anaesth,1993,40:459-464.
55. Gottlieb A,Sprung J,Zheng XM,et al.Massive subcutaneous emphysema and severe hypercarbia in a patient during endoscopic transcervical parathyroidectomy using carbon dioxide insufflation.Anesth Analg,1997,84: 1154-1156.
56. Tan PL,Lee TL,Tweed WA.Carbon dioxide absorption and gas exchange during pelvic laparoscopy.Can J Anaesth,1992,397:677-681.
57. Lister DR,Rudston-Brown B,Warriner CB,et al.Carbon dioxide absorption is not linearly related to intraperitoneal carbon dioxide insufflation pressure in pigs.Anesthesiology,1994,80:129-136.
58. Joris JL,Noirot DP,Legrand MJ,et al.Hemodnamic changes during laparoscopic cholecystectomy.Anesth Analg,1993,76:1067-1071.
59. Alberti A,Giannetto G,Littori F,et al.Abdominal compartment syndrome in video laparoscopic surgery. Etiopathogenetic aspects,physiopathology and personal experience[J].Chit Ital,1998,50(2-4):35-42.
60. Nagai H.A new method of laparoscopic cholecystectomy:an abdominal wall lifting technique without pneumoperitoneum[J]. Surgical Laparoscopy & Endoscopy,1991,7(2):126-1281.
61. Kitano S,Tomikawa M,Iso Y,et al. A safe and simple method to maintain a clear field of vision during laparoscopic cholecystectomy. Surg Endosc,1992, 6:197-198.
62. Gazayerli MM.The Gazayerli endoscopic retractor model 1.Surg Laparosc Endosc,1991,1:98-100.
63. Mouret P.La pneumoperitonie en suspension.Endomag,1991,2:2-3.
64. Banting S,Shimi S,Vander Velpen G,et al.Abdominal wall lift:low pressure pneumoperitoneum laparoscopic surgery.Surg Endosc,1993,7:57-59.
65. Smith RS,Fry WR,Tsoi EKM,et al.Gasless laparoscopy and conventional
instruments.The next phase of minimally invasive surgery.Arch Surg,1993, 128:1102-1107.
66. Kitano S,Iso Y,Tomikawa M,et al.A prospective randomized trial comparing pneumopeitoneum and U-shaped retractor elevation for laparoscopic cholecystectomy. Surg Endosc,1993,7:311-314.
67. Gutt CN,Heinz P,Held S,et al.Modular retraction system(MORES) for gasless laparoscopy.Surg Endosc,1996,10:584.
68. Nagai H,Kondo Y,Yasuda T,et al.An abdominal wall-lift method of laparoscopic cholecystectomy without peritoneal insufflation.Surg Laparosc Endosc,1993, 3:175-179.
69. Hashimoto D,Nayeem SA,Kajiwara S, et al.Laparoscopic cholecystectomy:an approach without pneumoperitoneum.Surg Endosc,1993,7:54-56.
70. Nakamura H, Kobori Y,Goseki N,et al. Fishing-rod-type abdominal wall lifter for gasless laparoscopic surgery.Surg endosc,1996,10:944-966.
71. Ponsky JL.Complication of laparoscopic cholecystectomy.Am J Surg,1991, 161:393-397.
72. Wolfe BM,Gardiner BN,Leary BF, et al.Endoscopic cholecystectomy:an analysis of complications.Arch Surg,1991,126:1192-1198.
73. Wittgen CM,Andrus CH,Fitgerald SD,et al.Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy.Arch Surg,1991, 126:997-1001.
74. Shuto K,Kitano S,Yoshida T,et al. Hemodynamic and arterial blood gas changes during carbon dioxide and helium pneumoperitoneum in pigs.Surg Endosc,1995, 9:1173-1178.
75. Pelosi MA, Pelosi MA 3rd. Laparoscopic hysterectomy with bilateral salpingo-oophorectomy using a single umbilical puncture[J]. N J Me d,1991, 88(10):721-726.
76. Pelosi MA, Pelosi MA 3rd. Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy)[J]. J Reprod Med,1992,37(7):588-594.
77. Remzi FH,Kirat HT,Kaouk JH,et al.Single-port laparoscopy in colorectal surgery[J].Colorectal Dis,2008,10(8):823-826.
78.曹强,季福,李可为.经脐单孔腹腔镜胆囊切除术[J].中国现代普通外科进展,2009,12(8)：713-714.
2. Edmonson JM. History of the instruments for gastrointestinal
3. endoscopy.Gastrointest endosc,1991,37(suppl):27-56.
4. Joris JL,Noirot DP,Legrand MJ,et al.Hemodynamic changes during laparoscopic cholecystectomy.Anesth Analg 1993,76:1067-1071.
5. Sharma KC,Brandsletter RD,Brensilver JM,Jung LD.Cardiopulmonary physiology and pathophysiology as a consequence of laparoscopic surgery.Chest, 1996,100:810-5.
6. Sharma KC,Kabinoff G,Ducheine Y,et al.Laparoscopic surgery and its potential for medical complications.Heart Lung,1997,26:52-64.
7. Bardoczky GI,Engelman E,Levarlet M,Simon P.Ventilatory effects of pneumoperi to neum monitored with continuous spirometry.Anaesthesia,1993, 49:309-311.
8. Fahy BG,Bamas GM,Flowers JL,et al.The effects of increased abdominal pressure on lung and chest wall mechanics during laparoscopic surgery.Anesth Analg,1995,81:744-750.
9. Don HF,Robson JG.The mechanics of the respiratory system during anesthesia:the effects of atropine and carbon dioxide.Anesthesiology,1965, 26:168-178.
10. Sly PD,Bates JHT,Kochi T,et al.Frequency-dependent effects of hypercapnia on respiratory mechanics of cats.J Appl Physiol,1987,62:444-450.
11. Hasel R, Arora SK, Hickey DR.Intraoperative complications of laparoscopic cholecystectomy.Can J Anaesth,1993,40:459-464.
12. Nagai H.A new method of laparoscopic cholecystectomy:an abdominal wall lifting technique without pneumoperitoneum[J]. Surgical Laparoscopy & Endoscopy,1991,7(2):126-1281.
13. Kitano S,Tomikawa M,Iso Y,et al. A safe and simple method to maintain a clear field of vision during laparoscopic cholecystectomy.Surg Endosc,1992, 6:197-198.
14. Gazayerli MM.The Gazayerli endoscopic retractor model 1.Surg Laparosc Endosc,1991,1:98-100.
15. Kitano S,Iso Y,Tomikawa M,et al.A prospective randomized trial comparing pneumopeitoneum and U-shaped retractor elevation for laparoscopic cholecystectomy.Surg Endosc,1993,7:311-314.
16. Anna-Maria Koivusalo,Ilmo Kellokumpu,Mika Scheinin.A Comparison of Gasless Mechanical and Conventional Carbon Dioxide Pneumoperitoneum Methods for Laparoscopic Cholecystectomy.Anesth Analg,1998,86:153-8.
17. Smith R,Fry W,Tsio E,et al.Gasless laparoscopu and conventional instruments.Arch Surg,1993,128:1102-7.
18. Alberti A,Giannetto G,Littori F,et al.Abdominal compartment syndrome in video laparoscopic surgery. Etiopathogenetic aspects,physiopathology and personal experience[J].Chit Ital,1998,50(2-4):35-42.
19. Ivankovich AD.Miletich DJ,Albrecht RF,et al,Cardiovascular effects of intraperitoneal insufflation with carbon dioxide and nitrous oxide in the dog.Anesthesiology,1975,42:281-287.
20. Drummond GB,Martin LVH.Pressure-volume relationships iin the lung during laparoscopy.Br J Anaesth,1978,50:261-269.
21. Wahba RWM,Beique F,Kleiman SJ.Cardiopumonary function and laparoscopic cholecystectomy.Can J A naesth,1995,42:51-63.
22. Bardoczky GI,Engelman E,Levalet M,et al.Ventilatory effects of pneumoperitoneum monitored with continuous spirometry.Anaesthesia,1993, 48:309-311.
23. Dumont L,Matty M,Mardirosoff C,et al.Changes in pulmonary mechanics during laparoscopic gastroplasty in morbidly obese patients.Acta Anaesthesiol Scand, 1997,41:408-413.
24. Purinate GD,Singh H.Ventilatory effects of laparoscopy under general
anaesthesia.Br J Anaesth,1992,68:211-213.
25. Wittgen CM,Andrus CH, Fitzgerald SD,et al.Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy.Arch Surg,1991, 126:997-1001.
26. Fahy BG,Barnas GM,Nagle SE, et al.Changes in lung and chest wall properties and abdominal insufflation of carbon dioxide are immediately reversible.Anesth Analg,1996,82:601-605.
27. Navarra G, Pozza E, Occhionorelli S, et al. One-wound laparoscopic cholecystectomy[J]. Br J Surg,1997,84(5):695.
28. Rao PP, Bhagwt S M, RaneA, et al. The feasibility of single port laparoscopic cholecystectomy:a pilot study of 20 cases[J]. HPB(Oxford),2008,10(5): 336-340.
29. Tacchino R, GrecoF, Matera D. Single incision laparoscopic cholecystectomy: surgery without a visible scar[J]. Surg Endosc,2009,23(4):896-899.
30. Kaouk JH, Haber GP, Goel RK, et al. Single-port laparoscopic surgery in urology: Initial experience[J]. Urology,2008,71(1):3-6.
31. Kaouk JH, Palmer JS. Single-port laparoscopic surgery: initial experience in children for varicocelectomy[J]. BJU Int,2008,102(1):97-99
32. Remzi FH. Kirat HT. Kaouk JH, et al. Single-port laparoscopy in colorectal surgery[J]. Colorectal Dis,2008,10(8):823-826.
33. Rao PP, Bhagwat SM, Rane A, et al. The feasibility of single port laparoscopic cholecystectomy:a pilot study of 20 eases[J]. HPB(Oxford),2008,10(5): 336-340.
34. Desai MM, Aron M, Canes D, et al. Single-Port Transvesical Simple Prostatectomy:Initial Clinical Report[J]. Urology,2008,72(5):960-965.
35. Rane A, Rao P, Rao P. Single-port-access nephrectomy and other laparoscopic urologic procedures using a novel laparoscopic port (R-Port)[J]. Urology,2008, 72(2):260-263.
36. Desai MM, Rao PP, Aron M, et al. Scarless single port transumbilical nephrectomy and pyeloplasty:first clinical report[J]. BJU Int,2008,101(1): 83-88.
37. Merchant AM, Cook MW, White BC, et al. Transumbilical Gelport Access
Technique for Performing Single Incision Laparoscopic Surgery (SILS)[J]. J Gastrointest Surg,2009,13(1):159-162.
38. Ponsky LE, Cherullo EE, Sawyer M, et al. Single access site laparoscopic radical nephrectomy: Initial clinical experience[J]. J Endourol,2008,22(4):663-665.
39. CanesD,DesaiMM,AronM, et al. Transumbilical single-port surgery:Evolution and current status [J]. Euro Urol,2008,54 (5):1020-1029.
40. Rao PP, Bhagwt S M, RaneA, et al. The feasibility of single port laparoscopic cholecystectomy:a pilot study of 20 cases[J]. HPB(Oxford),2008,10(5): 336-340.
41.张光永,胡三元,李峰.经脐单孔腹腔镜胆囊切除术[J].腹腔镜外科杂志,2009,14(1)：18-20.
1. Semm K. Atlas of gynecologic laparoscopy and hysteroscopy.Philade-Lphia, W.B.Saunders,1977.
2. Edmonson JM. History of the instruments for gastrointestinal endoscopy. Gastrointest endosc,1991,37(suppl):27-56.
3. Belt AE,Charnock DA. The cystoscope and its use.In:Cabot H,ed.Modern
4. Urology.Philadephia:Lea & Febiger,1936:15-50.
5. Gunning JE. The history of laparoscopy. J Repord Med 1974,12:222-226
6. Kelling G.Ueber oesophagoskopie, gastroskopie und kolioskopie.Munch Med Wochenschr,1902,21-24.
7. Ott D. Illumination of the abdomen (ventroscopia).J Akush Zhensk Boliez 1901,15:1045-1049.
8. Jacobaeus HC. Ueber die moglichkeit die zystoskopie bei untersuchung Seroser hohlungen anzuwenden. Munch Med Wochenschr,1910,57:2090-2092.
9. Kalk H. Erfarungen mit der laparoskopie. Z Klin Med,1929,111:303-348.
10. Orndoff BH.The peritoneoscope in diagnosis of diseases of the abdomen. J Radiol,1920,1:307-325.
11. Veress J.Neues instrument zur ausfurung von brust-oderbauch-punktionen und pneumothoraxbehandlung. Dtsch Med Wochenschr,1939,64:1480-1481.
12. Anderson JR, Dockerty MB, Waugh JM.Peritoneoscopy:an evaluation of Examinations.Proc Mayo Clin,1950,25:601-605.
13. Palmer R.Instrumentation et technique de la coelioscopie gynecologique. Gynecol Obstet,1947,19:261-275.
14. Frangenheim H. History of endoscopy.In:Gordon AG,Lewis BV ed.Gynecol-Ogical endoscopy.London:Chapman& Hall,1988:1.1-1.5.
15. Marlow J.History of laparoscopy,optics,fiberoptics and instrumentation.Clin Obstet Gynecol,1976,19:261-275.
16. Hasson HM.Open laparoscopy vs closed laparoscopy:a comparison of complication rates.Adv Plan Prevent,1978,13:41-50.
17. Davis JG.Filipi CJ.A history of endoscopic surgery. In:Arregui ME,Fitzgibbons RJ,Katkhouda N,et al.,ed.Principles of laparoscopic surgery-basic and advanced techniques.New York:Springer-Verlag.1995:3-20.
18. Berci G. Laparoscopy in general surgery.In:Berci G,ed.Endoscopy.New York:Appleton Century Croft,1976:382-401.
19. Litynski GS.Highlights in the history of laparoscopy. Frankfurt:BBernert Verlag,1996.
20. Schreiber JH.Early experience with laparoscopic appendectomy in women. Surg Endosc,1987,1:211-216.
21. Reddick EJ,Olsen DO,Daniel JF,et al.Laparoscopic laser cholecystectomy.Laser Med Surg Adv,1989,7:38-40.
22. Katkhouda N,Mouiel J.A new technique of surgical treatment of chronic duodenal ulcer without laparotomy by videocoeliscopy.Am J Surg,1991, 161:361-364.
23. Zucker KA, Bailey RW.Laparoscopic truncal and selective vagotomy for intractable ulcer disease.Semin Gastrointest Dis,1994,5:128-139.
24. Petelin JB.Laparoscopic approach to common duct pathology.Surg Laparosc Endosc,1991,1:33-41.
25. Carroll B,Chandra M,Pappioannou T,et al.Biliary lithotripsy as an adjunct to laparoscopic common bile duct stone extraction.Surg Endosc,1993,7:356-359.
26. Hunter JG,Trus TL,Brauum GD,et al.A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease.Ann Surg,1996 223:673-685.
27. Nathanson LK,Shimi S,Cuschieri A.A sutured laparoscopic cholecystojejunostomy evolved in an animal model. J R Coll Surg Edinb,1992, 37:215-220.
28. Goh P,Tekant Y,Issac J, et al.The technique of laparoscopic Billroth
Ⅱ gastrectomy.Surg Laparosc Endosc,1992,2:258-260.
29. Clayman RV,Kavoussi LR,Soper NJ,et al.Laparoscopic nephrectomy:initial case report .J Urol,1991,146:278-282.
30. Zornig C,Emmermann A,Von Waldenfels HA,ed al.Laparoscopic cholecystectomy without visible scar:combined transvaginal and transumbilical approach[J].Endocopy,2007,39(10):913-915.
31. Nagai HA.New method of laparoscopic cholocystecnomy;an abdominal wall lifting technique without periomoperitoneum.SLE,1991,7:126-128.
32. Ivankovich AD.Miletich DJ,Albrecht RF,et al,Cardiovascular effects of intraperitoneal insufflation with carbon dioxide and nitrous oxide in the dog.Anesthesiology,1975,42:281-287.
33. David G. Whalley,Samuel A.Irefin.Laparoscopic surgery of anesthesia:surgical laparoscopy,2005,2:12-26.
34. Gannedahl P,Odeberg S,Brodin L,et al.Effects of posture and pneumoperitoneum during anaesthesia on the indices of left ventricular filling. Acta Anaesthesiol Scand 1996,40:160-166.
35. Dorsay DA,Greene FL,Baysinger CL.Hemodynamic changes during laparoscopic cholecystectomy monitored with transesophageal echocardiography.Surg Endosc,1995,9:128-134.
36. Harris SN,Ballantyne GH,Luther MA,et al.Alterations of cardiovascular performance during laparoscopic colectomyLa combined hemodynamic and echocardiographic analysis.Anesth Analg,1996,83:482-487.
37. Joris JL,Noirot DP,Legrand MJ,et al.Hemodynamic changes during laparoscopic cholecystectomy.Anesth Analg,1993,76:1067-1071.
38. Kashtan J,Green JF,Parsons EQ,et al.Hemodynamic effects of increased abdominal pressure.J Surg Res,1981,30:249-255.
39. Dhoste K,Lacoste L,Karayan J,et al.Haemodynamic and ventilatory changes during laparoscopic cholecystectomy in elderly ASA III patients.Can J Anaesth, 1996,43:783-788.
40. Cullen DJ,Eger El.Cardiovascular effects of carbon dioxide in
man.Anesthesiology,1974,41:345-349.
41. Sharma KC,Kabinoff G,Ducheine Y,et al.Laparoscopic surgery and its potential for medical complications.Heart Lung,1997,26:52-64.
42. Fujii Y,Tanaka H,Tsuruokat S,et al.Middle cerebral arterial blood flow velocity increases during laparoscopic cholecystectomy.Anesth Analg,1994,78:80-83.
43. Morison CH,Riggs JRA.Cardiovascular collapse in laparoscopy.Can Med Assoc J,1974,111:433-437.
44. Yacoub OF,Cardona I,Coveller LA,et al.Carbon dioxide embolism during laparoscopy.Anesthesiology,1982,57:533-535.
45. Root B,Levy MN,Pollack S,et al.Gas embolismdeath after laparoscopy delayed by "trapping" in portal circulation.Anesth Analg,1978,57:232-237.
46. McGrath BJ,Zimmerman JE,Williams JF,et al. Carbon dioxide embolism treated with hyperbaric oxygen.Can J Anaesth,1989,36:585-589.
47. Drummond GB,Martin LVH.Pressure-volume relationships iin the lung during laparoscopy.Br J Anaesth,1978,50:261-269.
48. Wahba RWM,Beique F,Kleiman SJ.Cardiopumonary function and laparoscopic cholecystectomy.Can J A naesth,1995,42:51-63.
49. Bardoczky GI,Engelman E,Levalet M,et al.Ventilatory effects of pneumoperitoneum monitored with continuous spirometry.Anaesthesia,1993, 48:309-311.
50. Dumont L,Matty M,Mardirosoff C,et al.Changes in pulmonary mechanics during laparoscopic gastroplasty in morbidly obese patients.Acta Anaesthesiol Scand, 1997,41:408-413.
51. Purinate GD,Singh H.Ventilatory effects of laparoscopy under general anaesthesia.Br J Anaesth,1992,68:211-213.
52. Wittgen CM,Andrus CH, Fitzgerald SD,et al.Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy.Arch Surg,1991, 126:997-1001.
53. Fahy BG,Barnas GM,Nagle SE, et al.Changes in lung and chest wall properties and abdominal insufflation of carbon dioxide are immediately reversible.Anesth
Analg,1996,82:601-605.
54. Hasel R, Arora SK, Hickey DR.Intraoperative complications of laparoscopic cholecystectomy.Can J Anaesth,1993,40:459-464.
55. Gottlieb A,Sprung J,Zheng XM,et al.Massive subcutaneous emphysema and severe hypercarbia in a patient during endoscopic transcervical parathyroidectomy using carbon dioxide insufflation.Anesth Analg,1997,84: 1154-1156.
56. Tan PL,Lee TL,Tweed WA.Carbon dioxide absorption and gas exchange during pelvic laparoscopy.Can J Anaesth,1992,397:677-681.
57. Lister DR,Rudston-Brown B,Warriner CB,et al.Carbon dioxide absorption is not linearly related to intraperitoneal carbon dioxide insufflation pressure in pigs.Anesthesiology,1994,80:129-136.
58. Joris JL,Noirot DP,Legrand MJ,et al.Hemodnamic changes during laparoscopic cholecystectomy.Anesth Analg,1993,76:1067-1071.
59. Alberti A,Giannetto G,Littori F,et al.Abdominal compartment syndrome in video laparoscopic surgery. Etiopathogenetic aspects,physiopathology and personal experience[J].Chit Ital,1998,50(2-4):35-42.
60. Nagai H.A new method of laparoscopic cholecystectomy:an abdominal wall lifting technique without pneumoperitoneum[J]. Surgical Laparoscopy & Endoscopy,1991,7(2):126-1281.
61. Kitano S,Tomikawa M,Iso Y,et al. A safe and simple method to maintain a clear field of vision during laparoscopic cholecystectomy. Surg Endosc,1992, 6:197-198.
62. Gazayerli MM.The Gazayerli endoscopic retractor model 1.Surg Laparosc Endosc,1991,1:98-100.
63. Mouret P.La pneumoperitonie en suspension.Endomag,1991,2:2-3.
64. Banting S,Shimi S,Vander Velpen G,et al.Abdominal wall lift:low pressure pneumoperitoneum laparoscopic surgery.Surg Endosc,1993,7:57-59.
65. Smith RS,Fry WR,Tsoi EKM,et al.Gasless laparoscopy and conventional
instruments.The next phase of minimally invasive surgery.Arch Surg,1993, 128:1102-1107.
66. Kitano S,Iso Y,Tomikawa M,et al.A prospective randomized trial comparing pneumopeitoneum and U-shaped retractor elevation for laparoscopic cholecystectomy. Surg Endosc,1993,7:311-314.
67. Gutt CN,Heinz P,Held S,et al.Modular retraction system(MORES) for gasless laparoscopy.Surg Endosc,1996,10:584.
68. Nagai H,Kondo Y,Yasuda T,et al.An abdominal wall-lift method of laparoscopic cholecystectomy without peritoneal insufflation.Surg Laparosc Endosc,1993, 3:175-179.
69. Hashimoto D,Nayeem SA,Kajiwara S, et al.Laparoscopic cholecystectomy:an approach without pneumoperitoneum.Surg Endosc,1993,7:54-56.
70. Nakamura H, Kobori Y,Goseki N,et al. Fishing-rod-type abdominal wall lifter for gasless laparoscopic surgery.Surg endosc,1996,10:944-966.
71. Ponsky JL.Complication of laparoscopic cholecystectomy.Am J Surg,1991, 161:393-397.
72. Wolfe BM,Gardiner BN,Leary BF, et al.Endoscopic cholecystectomy:an analysis of complications.Arch Surg,1991,126:1192-1198.
73. Wittgen CM,Andrus CH,Fitgerald SD,et al.Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy.Arch Surg,1991, 126:997-1001.
74. Shuto K,Kitano S,Yoshida T,et al. Hemodynamic and arterial blood gas changes during carbon dioxide and helium pneumoperitoneum in pigs.Surg Endosc,1995, 9:1173-1178.
75. Pelosi MA, Pelosi MA 3rd. Laparoscopic hysterectomy with bilateral salpingo-oophorectomy using a single umbilical puncture[J]. N J Me d,1991, 88(10):721-726.
76. Pelosi MA, Pelosi MA 3rd. Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy)[J]. J Reprod Med,1992,37(7):588-594.
77. Remzi FH,Kirat HT,Kaouk JH,et al.Single-port laparoscopy in colorectal surgery[J].Colorectal Dis,2008,10(8):823-826.
78.曹强,季福,李可为.经脐单孔腹腔镜胆囊切除术[J].中国现代普通外科进展,2009,12(8)：713-714.