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◆要旨:乳癌内視鏡下手術における乳腺背側剝離には,大伏在静脈採取時に用いられるVein Harvest Equipment(以下,VH)(Johnson & Johnson社)が使用されることが多い.VHの利点は,センチネルリンパ節生検で用いる腋窩小切開創から挿入可能で,乳腺背側の剝離が行える点である.この手技により乳房温存術においては乳腺切除部と授動する残存乳腺の背側剝離が容易となり,皮下乳腺全摘術においては全乳腺の背側剝離が行える.今回VHの代替器具としてEndoscopic Vein Retractor, FREIBURG Model(Endoscopic Vein RetractorTM(以下,VR);Karl Storz Endoscopy社)を新規に採用し,乳癌11症例に使用した.VRの使用感はVHとほぼ同様で,乳腺背側剝離時に有用であった.また,VRは滅菌しての再使用が可能で,ステンレス製であるため負荷がかかっても破損しにくく,コスト削減の点でも有利である.VRは乳癌内視鏡下手術において使用可能なデバイスと考えられた.
During endoscopic surgery for breast cancer in which the fascia of pectoralis major is dissected, Vein Harvest Equipment(VH)(endoscopic instrument used for harvesting great saphenous vein) (Johnson & Johnson)is often used.
The advantage of using VH is that it becomes possible to dissect the dorsal layer of the mammary gland from a small axillar incision used for sentinel lymph-node biopsy.
This technique make it easy to dissect the dorsal layer of the excised and mobilized mammary gland in breast-conserving surgery, and all the dorsal layer of mammary gland in subcutaneous total glandectomy.
This time, we used Endoscopic Vein RetractorTM(VR) (KARL STORZ ENDOSCOPY)as the alternative instrument for VH and performed endoscopic breast surgery in 11 cases of breast cancer.
The usability of VR is equivalent to that of VH, so VR is useful for dissecting the dorsal layer of the mammary gland.
In addition, VR is a reusable and break-resistant stainless steel instrument, so using VR has an advantage in cost saving. VR is a usable instrument for endoscopic surgery for breast cancer.
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