ロボット支援下縦隔腫瘍手術に対する取り組み―側胸部アプローチ

Robot-assisted Thoracic Surgery for Mediastinal Tumor

胸部外科領域におけるロボット支援下手術（RATS）の導入は，世界に先駆けてYoshinoらが2001年に縦隔腫瘍に対して実施したが1），本邦におけるRATSの普及は薬事承認，保険収載をまたねばならなかった．当施設では2014年に3例の縦隔腫瘍に対するRATSを施行したが，2018年の保険収載以降に本格的に再始動した．本稿では，これまでの当施設での縦隔腫瘍に対するRATSへの取り組みの推移，切除例における臨床病理学的特徴と周術期成績を報告する．

In Japan, robot-assisted thoracic surgery （RATS） was introduced in thoracic surgery in 2001, but it did not become widespread. However, surgery for mediastinal tumors and lobectomy for lung cancer with RATS were covered by insurance in 2018 and are currently becoming popular as a general practice, following video-assisted thoracic surgery （VATS）. Forty-six patients with mediastinal tumors were treated by RATS from February 2014 to November 2022 in our institution. Theoretically, the RATS approach is performed from one side in a semi-supine position under CO2 insufflation as with the VATS approach of our institution. In the case of extended thymectomy, a bilateral approach is performed by changing the patient’s position. The median surgery time was 88 min, and the median surgery time in unilateral and bilateral approaches were 79 and 208 min, respectively. Blood loss during surgery was quite minimum, and no patients required conversion to VATS or thoracotomy. Regarding adverse events, postoperative bleeding was observed in one patient （2.2％）. RATS has been successfully introduced and expanded safely for mediastinal tumors. Considering further expansion of RATS indications while conducting verification by comparison with VATS in the future is necessary.