術前MRIを用いたロボット仙骨腟固定術における難度の予測

Predicting the difficulty of robotic sacrocolpopexy using preoperative MRI

◆要旨：ロボット仙骨腟固定術における仙骨前面の展開の難度を術前に予測する方法は限られている．仙骨前面の脂肪が，血管などの解剖学的位置の把握を困難にする場合が多い．今回，当院で施行した36例に対して，術前MRIを用いて仙骨前面の脂肪の厚みを計測し（仙骨前距離），仙骨前面の展開に要する時間（展開時間）との関連を検討した．結果，展開時間にはBMIの影響が強く，術者の執刀経験数を考慮しても，BMIは展開時間の延長に関連していた．一方で，仙骨前距離は手術難度の指標となりうる可能性が示唆されたが，今後症例数を積み重ねて検討する必要があると考察された．

　There are limited preoperative methods available to predict the difficulty of anterior sacral exposure during robotic sacrocolpopexy. The presence of fat in the anterior sacral plane often obscures the identification of blood vessels and other anatomical structures. Therefore, we measured the thickness of fat on the anterior sacral surface（anterior sacral distance）using preoperative magnetic resonance imaging in 36 cases performed at our hospital. We subsequently analyzed the relationship between this measurement and the time required for deployment of the anterior sacral surface（deployment time）. Our results indicated a strong influence of body mass index（BMI）on deployment time, as BMI was associated with prolonged deployment time even when accounting for the surgeon's level of experience. Additionally, our findings suggest that anterior sacral distance may serve as an indicator of surgical difficulty ; however, further research with a larger sample size is needed for more conclusive results.