Reduced port surgeryにおけるMini loop retractorTMを用いた展開の工夫

Usefulness of Mini loop retractorTM in reduced port laparoscopic gastrectomy

◆要旨：腹腔鏡手術の普及に伴い，さらなる疼痛軽減や整容面の向上を目指したreduced port surgeryが施行されつつある．しかし，郭清を伴う腹腔鏡下胃切除術において，肝圧排，胃挙上，膵脱転などの術野展開は重要であり，これまでにまとまった報告はない．Mini loop retractor^TMの先端をガーゼで保護したボクシンググローブ型ガーゼリトラクターを作製し，助手が両手で本リトラクターを操作し，肝圧排，胃挙上，膵脱転など視野展開を安全かつ容易に行いつつ，3ポートで胃切除術を施行しえたので，本リトラクターによる工夫と有用性を報告する．

　As laparoscopic surgery has become more popular, reduced port surgery is being performed to lessen postoperative pain and to aim for better cosmetic results. To our knowledge, there is no report of reduced port laparoscopic gastrectomy for gastric cancer because surgical field is important for lymph node dissection. We modified Mini loop retractor^TM and inserted it into the assistant's port to perform reduced port laparoscopic gastrectomy. Mini loop retractor^TM was inserted in the left upper and middle abdomen, and a roll of gauze was attached to its tip to make it atraumatic. Displacement of liver, mobilization of stomach, and rolling of pancreas were performed safely and easily by using this retractor. This paper is the first to report the reduced port laparoscopic gastrectomy with lymph node dissection using boxing glove shaped gauze retractor.