腹腔内での臓器把持用の機器Free Jaw（FJ）Clipの開発と臨床応用

Development and application of a new device, the FJ Clip, to hold organs in the abdominal cavity during laparoscopic surgery

◆要旨：筆者らは，腹腔内での臓器把持用の機器を眼鏡枠メーカー，シャルマン社と2サイズ開発しreduced port surgeryに使用した．腹腔鏡用鉗子で操作可能で，ステンレス製で再利用可能である．把持力が強く，組織挫滅が少なく，FJ（Free Jaw）Clipと名付けた．12mm用を胃GISTに対する5症例の腹腔鏡下胃局所切除に使用したが，胃壁の把持牽引は有効で挫滅はなかった．5mm用は主に臍部1cm切開2ポート＋細径鉗子による腹腔鏡下胆囊摘出術での胆囊の腹側への展開に用いた．術者を開発者に限定した20例の手術時間は88.7±13.3分で，FJ Clipを用いなかった19例の118.5±31.6分に比べ有意に短縮された．FJ Clip はreduced port surgeryに非常に有効な機器であると考えられる．

We have developed a clip that can be used instead of forceps to hold organs in the abdominal cavity. The new so-called FJ（free jaw） Clip, was manufactured for us by Charmant Inc. （Sabae City, Fukui） and is made of stainless steel. Because it can be sterilized, it is reusable and thus economical. It has a strong grasp but causes no or only negligible organ damage. We began with a clip that requires a 12-mm port and used this clip for laparoscopic resection of gastric GIST. We used the clip effectively to hold the stomach wall in 5 cases, and there was almost no tissue damage, so the clip proved to be a useful substitute for forceps. We then developed a clip that requires only a 5-mm port, and we used this clip mainly to grip the abdominal side of the gallbladder during laparoscopic gallbladder extraction. The procedure involves a 1-cm umbilical incision, 2 ports, and thin forceps. The author, who devised the FJ Clip, has, to date, performed 20 laparoscopic cholecystectomies using the clip. No intra-operative problems were encountered, and the average operation time was 88.7±13.3 minutes（substantially shorter than the author's average laparoscopic cholecystectomy time of 118.5±31.6 minutes）. No postoperative complications ensued. Thus far, the FJ Clip has proven to be very effective for holding organs in the abdominal cavity during laparoscopic surgery. According to our experience, we believe the newly developed FJ Clip will replace conventional forceps for various tasks in reduced-port laparoscopic surgery.