ロボット支援胸腔鏡下に11cmの成熟奇形腫を摘出した1例

A case of a mature teratoma successfully resected by robot-assisted thoracoscopic surgery

◆要旨：巨大縦隔腫瘍は胸腔鏡手術やロボット支援胸腔鏡手術（RATS）では視野確保が困難であるため，胸骨正中切開で摘出されることが多い．われわれは11cmの前縦隔腫瘍をRATSで安全に摘出しえたので報告する．症例は20代，男性．胸部単純X線写真で異常を指摘され，紹介となった．腫瘍は左腕頭静脈の高さから前縦隔左側に認めた．左側胸部アプローチでda Vinci Xiを使用し，8mmのダヴィンチポート3個と，8mmの助手用エアシール^TMポート1個を留置してCO₂送気下に手術を行った．横隔神経を損傷しないようFirefly^TM蛍光観察機能を用いて横隔動・静脈を確認する工夫を行った．合併症はなく，手術翌日に自宅退院した．巨大な前縦隔腫瘍であってもRATSで安全に摘出可能であった．

　Giant mediastinal tumors are often resected through a median sternotomy because it is difficult to secure a clear operative field through thoracoscopic surgery or robot-assisted thoracoscopic surgery（RATS）. We report a case in which an 11cm anterior mediastinal tumor was safely resected by RATS. The patient was a man in his 20s. An abnormality was detected on a chest X-ray, and the patient was referred to our hospital. Chest computed tomography showed a 10cm×7cm anterior mediastinal tumor on the left side, beginning at the level of the left brachiocephalic vein. The surgery was performed using da Vinci Xi via left thoracic approach, with three 8mm da Vinci ports and one 8mm assistant AirSeal^TM port under CO₂ insufflation. We identified the phrenic artery and vein using the Firefly^TM fluorescent ICG imaging to avoid damage to the phrenic nerve. There were no complications, and the patient was discharged the day after surgery. Even a giant anterior mediastinal tumor could be safely resected by RATS with careful intraoperative management.