胃癌に対するロボット支援胃切除のこれまでの歩みと将来展望

Robotic gastrectomy for gastric cancer : History, current status, and future perspectives

◆要旨：本邦におけるロボット支援胃切除術は2000年代初頭に導入された．腹腔鏡手術の技術的限界を補完する先進的な術式として発展し，2018年に保険収載され，2022年に診療報酬増点が認められた．保険収載以降急速に普及が進み，国内外でのエビデンスも蓄積されてきている．日本内視鏡外科学会が中心となり制度・指針の整備を進め，術者・施設要件の緩和が進み，手術の実施環境が大きく拡充してきている．また，国産を含め多機種のロボットが市場へ続々と参入し，Surgical Intelligence^®の活用や人工知能による解析，遠隔手術などの先端技術との融合も進みつつあり，外科医療全体の質的向上と革新が強く期待されている．

　This review article provides a comprehensive overview of the development, current status, and future prospects of robotic gastrectomy. Robotic gastrectomy was first introduced in Japan in the early 2000s as an advanced surgical approach designed to overcome the technical limitations of conventional laparoscopic surgery. Since its inclusion under the national health insurance system in 2018, and the subsequent approval of additional reimbursement in 2022, the procedure has rapidly gained widespread adoption. Accumulating evidence from both domestic and international studies has further validated its clinical value. Under the leadership of the Japan Society for Endoscopic Surgery, regulatory frameworks and clinical guidelines have been progressively established, accompanied by the relaxation of surgeon and institutional requirements, thereby significantly expanding the operative environment. Concurrently, a growing number of robotic systems—including domestically developed platforms—have entered the market. Integration with cutting-edge technologies such as utilization of Surgical Intelligence^®, artificial intelligence-based analytics, and development of telesurgical systems is also in progress. These advancements are expected to contribute significantly to improved surgical outcomes and the overall innovation of surgical practice.