腹腔鏡下手術用電動ブラシの開発と胆嚢摘出術への応用

Development of Electric Brush Dissection Instrument for Laparoscopic Surgery and for Cholecystectomy Applications

　腹腔鏡下手術用にスピンタイプ剥離用電動ブラシ（Kakihara�s brushing dissector）を試作し，これを38例の胆嚢摘出術に適用した．電動ブラシはCalot三角内の脂肪組織を容易に液状化し，胆管・脈管を全く損傷せず露出し得た．手術時間は，術中胆道造影施行例が82±34分（N＝18），非施行例が71±13分（N＝20）であった．一方，従来の鉗子による剥離法では，それぞれ112±31分（N＝97），108±45分（N＝55）であり，電動ブラシ法はそれぞれ有意に手術時間を短縮した（P＜0.001,P＜0.0001）．電動ブラシは，安価でありながら安金で剥離能力の優れた器械であると考えられる．

We have developed an electric brush dissection instrument (Intellectual Property Patent, 1995 by Minoru Kakihara) to assist in safe and effective dissection during laparoscopic surgery. This instrument is com-prised of a long thin shaft, rechargeable batteries, and a unique detachable spin-type brush tip. This brush tip has the ability to liquefy fatty tissue during dissection with its alternating circular motion. After gaining patient consent, we have performed 38 clinical laparoscopic cholecystectomy cases, using this device.