da Vinci SP surgical systemを用いたロボット支援下幽門側胃切除術における手術手技の工夫—単孔式ロボット支援手術における助手を必要としない展開操作と安全な郭清操作の工夫

Technical modifications for robotic distal gastrectomy using the da Vinci SP surgical system : Application of two left-hand instruments and soft-coagulation double bipolar technique

◆要旨：da Vinci SP surgical system（DVSP）を用いた幽門側胃切除術における，左手2鉗子操作とソフト凝固を用いたダブルバイポーラ法を中心とした手技の工夫と治療成績を報告する．臍部に加え，助手ポートを1本追加した．左手2鉗子とorgan retractorで助手に頼らず組織を展開し，ダブルバイポーラ法で郭清を行った．2024年4月から11月までにDVSPで幽門側胃切除術を施行した胃癌患者7例を対象とした．手術時間中央値321分，出血量中央値32g．全例でR0切除を達成した．術後合併症（GradeⅡ以上）は認めなかった．DVSPを用いた幽門側胃切除術は安全に施行可能であった．

　We report our initial experience and technical modifications for robotic distal gastrectomy（RDG） using the da Vinci SP surgical system（DVSP）, focusing on the use of two left-hand instruments and a soft-coagulation double bipolar technique. A single 3.5-cm umbilical incision was made for the SP port, and one additional assistant port was placed. During lymph node dissection, the two left-hand instruments with an organ retractor provided adequate tissue handling and countertraction, while the Maryland forceps handled by the right hand was used for the double bipolar technique with soft-coagulation. Seven patients with gastric cancer who underwent RDG using DVSP at our institution between April and November 2024 were included in the study. The median age was 73years, with 3males and 4females. The median operation time was 321minutes, and the median estimated blood loss was 32g. R0 resection was achieved in all patients. No postoperative complications of Clavien-Dindo grade Ⅱ or higher occurred. RDG using DVSP was safely performed by employing technical modifications, including the use of two left-hand instruments, the soft-coagulation double bipolar technique, and an organ retractor.