先端球状無外傷性腸管クリップの開発

Development of a novel atraumatic intestinal clip with ball-shaped tips

◆要旨：直腸癌に対するロボット支援手術を含む腹腔鏡下前方切除術において，直腸切離は最も難易度の高い手技の1つである．切離前には，吻合部再発を防ぐ目的で残存直腸内の洗浄が行われ，またリニアステープラーを安全に直腸にアプローチする目的で腸管クリップが使用される．しかし，骨盤深部で直腸を直交的に閉鎖する操作は技術的難易度が高く，さらにロボット支援手術では，助手が腹腔鏡手術に不慣れな場合もあり，クリップ操作に難渋する可能性がある．そこでわれわれは，骨盤深部でも安全かつ確実に使用可能な先端球状無外傷性腸管クリップを開発した．本稿では，その開発経過および臨床使用経験について報告する．

Rectal transection is one of the most technically demanding procedures in laparoscopic and robot-assisted anterior resection for rectal cancer. Before transection, intraluminal lavage of the residual rectum is performed to reduce the risk of anastomotic recurrence, and intestinal clips are applied to facilitate safe access of the linear stapler to the rectum. However, perpendicular closure of the rectum in the deep pelvis is technically challenging. Moreover, in robot-assisted surgery, the assistant may be inexperienced with laparoscopic techniques, making clip application particularly difficult. To address these issues, we developed a novel atraumatic intestinal clip with ball-shaped tips that allows safe and reliable application even in the deep pelvis. In this article, we describe the development process and report our initial clinical experience with this device.