遠隔内視鏡手術の現状と展望

Current status and future perspectives of remote endoscopic surgery

◆要旨：手術支援ロボット，高速通信網，情報処理技術の進展により，遠隔内視鏡手術の臨床応用に向けた環境が整いつつある．本総説では，国内外の動向，通信遅延やサイバーセキュリティを含む技術的課題，提供体制や制度設計の現状を概説した．特に，国内実証研究の成果と，社会実装を念頭に策定された遠隔手術ガイドライン第2版の意義を整理する．遠隔内視鏡手術は，医療資源の偏在是正や外科医教育の推進に資する可能性を有しており，今後は学会主導の下で，安全性と倫理性を重視した段階的導入が求められる．

　Advances in surgical robotic systems, high-speed communication networks, and information processing technologies have created a practical foundation for the clinical application of telesurgery in endoscopic surgery. This review summarizes recent domestic and international developments in remote endoscopic surgery, focusing on technological requirements, organizational frameworks, and regulatory considerations necessary for safe implementation. Key technical issues, including communication latency, jitter, network redundancy, and cybersecurity, are discussed based on recent experimental and clinical validation studies. In Japan, stepwise domestic verification studies using commercial networks and robotic platforms have demonstrated the technical feasibility of remote surgical support under controlled conditions. These achievements culminated in the publication of the second edition of the Clinical Practice Guidelines for Telesurgery, which comprehensively address both technical requirements and healthcare delivery systems with a strong emphasis on social implementation. The guidelines clarify institutional requirements, surgeon qualifications, role sharing between local and remote teams, and emergency response protocols. Remote endoscopic surgery has the potential to mitigate regional disparities in surgical care, enhance surgical education through remote mentoring, and promote international collaboration by integrating surgical expertise with advanced robotic platforms. Future dissemination should be guided by academic societies, adhering to the core principles of cautious, stepwise implementation and evidence-based practice, with patient safety and ethical considerations as the highest priorities.