ロボット支援下幽門保存胃切除術における体腔内手縫い胃々吻合

Robotic pylorus-preserving gastrectomy with intracorporeal hand-sewn anastomosis

◆要旨：手術支援ロボットであるda Vinci^® Surgical System（DVSS）は三次元高精度画像と関節機能を有した鉗子を使用し従来の腹腔鏡下手術の技術的困難点を補完する機器である．DVSSは縫合手技において特に有用な機器となりうる．腹腔鏡下胃癌手術において幽門側胃切除術や胃全摘術は自動縫合器や自動吻合器を用いた体腔内再建法がほぼ定型化しているが，幽門保存胃切除や噴門側胃切除といった縮小手術での体腔内再建法はいまだ完全な定型化には至っていない．今回，DVSSを用いた幽門保存胃切除術における胃々再建を体腔内・手縫い吻合で施行した5例を経験したので，手技の概要と治療成績を報告する．

　The surgical support robot da Vinci^® Surgical System （DVSS; Intuitive Surgical Sunnyvale, CA, USA） is a device that uses 3D high-resolution imaging and forceps with a joint function to circumvent the technical challenges involved in conventional laparoscopic surgeries. DVSS can be particularly useful in suturing procedures. In laparoscopic gastric cancer surgery, the intracorporeal reconstruction method that uses automatic suturing and anastomosis devices has essentially been standardized for distal and total gastrectomies. On the other hand, intracorporeal reconstruction methods for reduction surgery, such as pylorus-preserving and proximal gastrectomies, have not yet been completely standardized. Here, we report five cases of pylorus-preserving gastrectomies, in which hand-sewn gastrogastric anastomosis was intracorporeally performed using DVSS and describe the procedure and treatment outcomes.