直腸癌に対する腹腔鏡下前方切除術における助手の役割

The role of the first assistant in laparoscopic anterior resection for patients with rectal cancer

◆要旨：【背景目的】腹腔鏡下前方切除術では術者と助手の役割を明確にすることでスムースな術野展開がえられる．術者と助手の役割を定形化することは，腹腔鏡下手術を修練する外科医にとって手技習得に大きく寄与する．剝離部位ごとの術野展開のポイントを，助手の役割を中心に提示する．【方法】剝離部位により次の7つの場面に分けて手術を進めていく．①内側アプローチ，②上方向郭清，③後壁剝離，④前壁剝離，⑤右側壁剝離，⑥左側壁剝離，⑦間膜の処理・吻合【まとめ】助手の習熟度により手術時間が短くなる傾向にあり，術者と助手の共通認識と手術手技習得のための術野展開の定形化は腹腔鏡下直腸癌手術において大切である．

　Background and objective : In laparoscopic anterior resection, the operative field can be smoothly secured when the roles of the surgeon and first assistant are clearly defined. Definition of these roles contributes to the training of surgeons for laparoscopic surgery. We define the important points required to secure the surgical field in individual exfoliation areas, with a focus on the role of the first assistant. Method : For each exfoliation area, surgery is performed through the following 7 steps: ①interior approach, ②upward exfoliation, ③posterior wall exfoliation, ④anterior wall exfoliation, ⑤right wall exfoliation, ⑥left wall exfoliation, and⑦treatment/anastomosis of the mesentery. Conclusion : The operation time tends to be shortened when the proficiency of the first assistant is high. In laparoscopic surgery for rectal cancer, it is important for the surgeon and first assistant to have a common purpose and to ensure a uniform surgical field to facilitate good surgical techniques.