気胸を併用した左側臥位胸腔鏡下食道切除術

Surgical procedure of thoracoscopic esophagectomy under pneumothorax placed in the left lateral decubitus position

◆要旨：気胸を併用した左側臥位胸腔鏡下食道切除術の術式と治療成績について報告する．気胸下（4～6mmHg）で行うため，12mmポートから挿入できる縦隔展開鈎を独自に作製した．気胸下の左側臥位胸腔鏡下食道切除術では，肺圧排の手間がかからず，術野展開が行いやすいが，下縦隔は左側へ落ち込む．このため，食道を周囲組織とともにテーピングすることで，右側へ牽引挙上する．2010年4月の導入後30例に施行したが，手術時間は5例以降すみやかに短縮し，最近の5例では190分となった．これまで重篤な術中合併症は経験していない．気胸併用左側臥位胸腔鏡下食道切除術は胸腔鏡下食道切除術の普及に有用で安全な術式である．

　Here, we reported the surgical procedure and outcomes of thoracoscopic esophagectomy under pneumothorax placed in the left lateral decubitus position. Because this procedure was performed under pneumothorax （4-6 mmHg）, we constructed a laparoscopic retraction device for retaining the surgical view of the mediastinum to insert from 12mm trocar. The right lung collapsed by pneumothorax could be easily excluded from the surgical field and the surgical view surrounding the esophagus could be retained. However, the inferior mediastinum tends to fall to the left side. Therefore, we pulled the esophagus with surrounding structures to the right side using loop retractor. We introduced this procedure from April 2010, and since then, we have treated 30 cases with thoracic esophageal cancer by this surgical procedure. The operation time significantly decreased after the initial 5 cases. In the recent 5 cases, the operation time was 190 minutes. We have not yet experienced severe intraoperative morbidity. Therefore, thoracoscopic esophagectomy under pneumothorax placed in the left lateral decubitus position is a safe and useful procedure and should be used more frequently in endoscopic esophageal surgery.