腹腔鏡下大腸切除術における安全な体位固定器具の改良

The improvement of a safe physique fixation appliance in laparoscopic-assisted colectomy

◆要旨：腹腔鏡下大腸切除術（以下，LAC）における体位変換は，大網や小腸を排除し良好な術野を展開する方法の1つとして重要である．当科で過去14年間に施行したLAC症例340例中2例（0.6％）に上肢の神経障害を認め，内訳は正中神経麻痺（1例），撓骨神経麻痺（1例）であった．いずれの症例も術直後から上肢のしびれや麻痺が出現し，その原因は手台からの上肢落下，術中の神経圧迫と推測された．この2症例の経験から，筆者らが独自に作製した上肢固定具に改良を加え，現在行っている安全かつ容易な体位固定の工夫について報告する．

　During laparoscopic-assisted colectomy（LAC）, position change may be required to obtain a clear operative field by removing the greater omentum and small intestine. It is important to maintain a safe operative position. Of the 340 patients who underwent LAC in our department during the past 14 years, two（0.6％）developed upper limb neuropathy. One patient had median nerve palsy, while the other had radial nerve palsy. Both patients developed numbness and/or palsy of the upper limb immediately after surgery. These symptoms were presumed to be attributable to drop of the upper limb from the operating table or nerve compression during surgery. Based on our experience with these two cases, we designed a safe and easy method of position fixation using a device for fixing the upper limbs, which we produced and improved on our own. We report here this contrivance herein.