心房細動に対する胸腔鏡下mini MazeおよびNavigatorの使用経験

Thoracoscopic mini-Maze procedure for atrial fibrillation : first case report of using the Navigator in Japan

心房細動の外科治療はMaze法により満足のいく結果を得ているが，胸骨正中切開による人工心肺心停止下に行う術式であり，複雑で侵襲が大きい．これに対し，安全かつ確実な低侵襲治療法が期待され，焼灼機器の開発，切開線の簡略化により，胸腔鏡下mini Mazeが可能となった．今回，胸腔鏡下mini Mazeならびに本邦でのNavigatorの初使用例を報告する．手術は分離肺換気による全身麻酔下に側臥位とし，ポート孔を2か所と小開胸を置き，胸腔鏡下にNavigatorの誘導により肺静脈左房接合部を左右それぞれ焼灼し，左心耳を切除した．Navigatorは，安全かつ確実な手技を行ううえで有効な機器と考えられる．

　Surgery for treating atrial fibrillation by the Maze procedure has been successful. However, the Maze procedure requires a median sternotomy and cardiopulmonary bypass, which make the procedure both complex and invasive. The thoracoscopic mini-Maze procedure, on the other hand, has become widespread throughout western countries because of its effectiveness, safety and easiness. The purpose of this study is to report the thoracoscopic mini-Maze procedure performed using the Cardioblate^ⓇNavigator^TM Tissue Dissection Device. Under general anesthesia using a double lumen tube, two ports and a small thoracotomy were created and pulmonary vein isolation and ganglion plexi ablation were achieved bilaterally using a radiofrequency ablation device and the Navigator. Furthermore, the left atrial appendage was removed. The thoracoscopic mini-Maze procedure is considered minimally invasive, safe, and moreover, conclusive for treating atrial fibrillation.