若手教育を念頭に置いた小切開先行腹腔鏡補助下結腸右半切除の有用性

Laparoscopy assisted right hemicolectomy preceded by small incision : Usefulness for education of young surgeons

◆要旨：【緒言】大腸癌の内視鏡外科手術教育を行う際には，安全性と両立させる必要がある．今回筆者らは当院の小切開先行腹腔鏡補助下結腸右半切除術が，教育のために初級者が施行しても手術の質を担保しうるかを検討した．【方法】対象は2014年から2017年に癌に対し上記手術を行った82例で，手術の質の指標を手術時間，出血量，郭清度，リンパ節郭清個数，合併症の有無，術後在院日数とし，術者の経験に応じ3群に分け比較した．【結果】手術の質の指標を3群間において比較したが，有意な差を認めなかった．【結論】小切開先行腹腔鏡補助下結腸右半切除術は，初級者が施行しても質が担保された安全性の高い手術法であり，教育に有用と考えられた．

　［Introduction］ Given the prevalence of laparoscopic surgery for colorectal cancer, laparoscopic surgery training should be provided to young surgeons while ensuring surgical quality and safety. In this study, we examined whether laparoscopy assisted right hemicolectomy preceded by small incision performed by young inexperienced surgeons in our hospital can ensure surgical quality and safety. ［Methods］ The subjects were 82 patients who underwent the above described surgery for cancer from 2014 to 2017. The surgical quality was judged by operation time, hemorrhage volume, degree of lymphadenectomy, number of dissected lymph nodes, presence of complications, and number of postoperative hospital days. We divided the subjects into three groups depending on the experiences of the surgeons. ［Results］ The above described indicators for surgical quality were compared among the three groups. There was no significant difference in any of the indicators. ［Conclusion］ The laparoscopy assisted right hemicolectomy preceded by small incision was found to be a highly safe surgical procedure for which the quality was maintained even for inexperienced surgeons. This indicated that the procedure is suitable for educational purpose.