単孔式腹腔鏡下手術デバイスを用いて経肛門的直腸腫瘍切除を施行した2例

The excision of a lower rectal tumor by transanal endoscopic surgery with single incision laparoscopic surgery device : A report of two cases

◆要旨：当科で使用している単孔式腹腔鏡下手術のデバイスを用いて行う経肛門的直腸腫瘍切除を2例経験した．1例目は肛門にウーンドリトラクターXS^Ⓡを装着し手袋法で気囊，腫瘍肛門側から粘膜下層を剝離し腫瘍を切除した．手術時間は148分であった．2例目はラッププロテクターミニ^Ⓡを肛門に装着しEZアクセス^Ⓡを用いて気囊，腫瘍の肛門縁がラッププロテクター^Ⓡに近接し視野不良であったため口側の粘膜剝離を腹腔鏡下に行い肛門側は直視下に剝離し腫瘍を切除した．手術時間は65分であった．症例を重ねる必要があるが，本術式は良好な視野で直腸腫瘍切除が施行可能であり標準化される可能性があると思われた．

Two patients underwent the excision of a lower rectal tumor by transanal endoscopic surgery with single incision laparoscopic surgery device. Case1 : A Wound Retractor XS^Ⓡ size with glove was placed in the anus, and the bowel was extended by carbon dioxide insufflation. The tumor was completely removed by excision into the submucosa layer. The operation time was 148 min. Case2 : A Lap Protector mini^Ⓡ with EZaccess^Ⓡ was placed in the anus. However, the anal edge of the tumor was too close from the Lap Protector^Ⓡ and anal side of the tumor was excised with a direct view. The operation time was 65 min. This procedure might be standardized, because it provides a good field of view.