右側結腸進行癌に対する腹腔鏡下右半結腸切除術の手技のポイント

Laparoscopic right-hemicolectomy for advanced cancer of the right colon

◆要旨：本稿では進行右側結腸癌に対する腹腔鏡下右半結腸切除術の特に腹腔鏡操作について解説する．大腸癌に対しての腹腔鏡下手術が開発された当初は外側アプローチが主流であったが，現在はsurgical trunkに沿ったD3リンパ節郭清，ならびに内側から頭外側に向けての右半結腸の後腹膜からの剝離・授動を，外側からの右半結腸の授動より先行する内側アプローチが主流になった．腹腔鏡下手術が，単に傷が小さい手術というだけではなく，開腹手術より合併症発生率が低率な，より安全な手術と認識されるためにも技術の修練が必要である．

　In this report, technical aspects of laparoscopic right-hemicolectomy for advanced right-sided colon cancer is described in detail. Concerning the laparoscopic approach, the lateral-to-medial approach, in which the right sided colon is mobilized laterally, was used in the early era. By this approach, however, the mobilized intestine is likely to fall into the surgical field during lymph node dissection, possibly blocking the visual field. Therefore recently, medial-to-lateral approach is widely adopted. To expand the use of minimum invasive surgery for advanced colorectal carcinoma, it to acquire high-level technical skills as well as to confirm the oncological safety of laparoscopic surgery. In the future, laparoscopic surgery for colorectal carcinoma performed by experts may be recognized as more safe procedure than open surgery.