胸腔鏡下手術における単回使用開創器を用いた気漏確認の簡便な方法

A novel method to confirm the sealing of air leakage in thoracoscopic surgery

◆要旨：胸腔鏡下手術時における巻き上げ式の単回使用開創器を利用した簡便な気漏確認法を紹介する．方法は気漏確認の際に，①体位変換を行い開創器の挿入されたポートを最高位とする，②開創器を体外に伸展，他のポートは用手的に閉鎖し，胸腔内に十分に生理食塩水を貯留する，③術側肺を膨張させ胸腔内に空気が残らないようにして，伸展した開創器内を水柱で満たす，④術側肺を加圧し伸展した開創器内で気漏の有無を確認する，である．本法では気漏の部位確認ができないが，術側胸腔内の気漏の有無については一括して確認が可能である．

　To confirm the sealing of air leakageis important to reduce complications after thoracic surgery, Therefore, Applied Alexis^Ⓡis used in our department to confirm it. Method : Firstly, the operating table is rotated to keep the port for Applied Alexis^Ⓡto the highest position when intrathoracic maneuvers are completed. Secondly, Applied Alexis^Ⓡis pulled up and the thoracic cavity is filled with saline. Next, the anesthesiologist expands the lungs completely.We then observe whether the bubble comes up in the water column of Applied Alexis^Ⓡ. Though the air leakage point cannot be identified by using Applied Alexis^Ⓡ, air leakage can be confirmed easily by completely expanding the lungs. This method contributes to the shortening of the operation time and decreasing the unexpected air leakage after surgery.